Clinical and structural outcome 22 years after acromioplasty without tendon repair in patients with subacromial pain and cuff tears

• Published in: Journal of shoulder and elbow surgery 2017-07, Vol.26 (7), p.1262-1270
• Main Authors: Ranebo, Mats C., MD, Björnsson Hallgren, Hanna C., MD, PhD, Norlin, Rolf, MD, PhD, Adolfsson, Lars E., MD, PhD
• Format: Article
• Language: English
• Subjects: Acromion - surgery; acromioplasty; Adult; Aged; Aged, 80 and over; cuff tear arthropathy; Disease Progression; Female; Follow-Up Studies; Humans; long-term; Male; Middle Aged; natural history; Orthopedics; Radiography; Retrospective Studies; rotator cuff; Rotator Cuff Injuries - complications; Rotator Cuff Injuries - diagnostic imaging; Rotator Cuff Injuries - physiopathology; Rotator Cuff Tear Arthropathy - diagnostic imaging; Rotator Cuff Tear Arthropathy - etiology; Rotator Cuff Tear Arthropathy - physiopathology; Shoulder; Shoulder Joint - diagnostic imaging; Shoulder Joint - physiopathology; Shoulder Pain - surgery; tear progression; Time Factors; Ultrasonography; Young Adult
• ISSN: 1058-2746; 1532-6500; 1532-6500
• DOI: 10.1016/j.jse.2016.11.012

Background Long-term results regarding tear progression, arthropathy, and clinical scores of unrepaired rotator cuff tears are largely unknown. This study investigated whether the condition of the glenohumeral joint and rotator cuff had deteriorated at a minimum of 20 years after an acromioplasty without cuff repair and assessed the clinical results. Methods A retrospective analysis was conducted of a consecutive series of patients treated between 1989 and 1993 with acromioplasty without cuff repair due to subacromial pain and cuff tear. At follow-up results of x-ray, ultrasonography, and clinical scores were recorded. Results At a mean of 22 years (range, 21-25 years), 69 patients were available for follow-up with Western Ontario Rotator Cuff Index, Constant-Murley (CM) score, x-ray, and ultrasonography. Mean age at operation was 49 years (range, 19-69 years). There were 45 partial-thickness tears (PTT) and 24 full-thickness tears (FTT). Of 23 patients with FTT, 17 (74% with x-ray) had developed cuff tear arthropathy (Hamada ≥2) and 20 (87% with ultrasonography) had progressed in tear size. Mean relative CM in patients with FTT and cuff tear arthropathy was 62 (standard deviation [SD], 27), and the mean WORC was 58% (SD, 26%). In the 43 PTT patients, 3 (7% with x-ray) had developed cuff tear arthropathy and 16 (42% with ultrasonography) had tear progression. With PTT at follow-up, the mean relative CM was 101 (SD, 22), and the mean WORC was 81% (SD, 20%). Conclusions After an acromioplasty, most unrepaired full-thickness tears will, in long-term, increase in size and be accompanied by cuff tear arthropathy changes. Most partial thickness tears remain unchanged; cuff tear arthropathy is rare, and clinical scores generally good.