Shoulder & Elbow Clinical PaperRelationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion
Section snippets
Patient selection
Between March 2008 and April 2011, all patients with a rotator cuff tear evaluated in a shoulder clinic were considered potentially eligible for inclusion in this prospective study. Patients with rotator cuff tears defined as 2 or more tendons, with muscle fatty infiltration beyond grade 3 diagnosed by computed tomography (CT) arthrography according to Goutallier's criteria, were included in the study.17 To ensure that the tendon was nonfunctional, fatty infiltration beyond grade 3 was used as
Results
The study inclusion criteria were met by 112 patients; 12 patients were excluded from the study because of incomplete documentation, and no patients declined to participate. Thus, 100 patients (50 men and 50 women) with a mean age of 67.7 ± 8.2 years (range, 50-84 years) were available for the analysis. Baseline characteristics are summarized in Table I.
The average κ value for interobserver agreement of fatty infiltration evaluation by the Goutallier system was 0.92, representing a good
Discussion
The ideal management of massive chronic rotator cuff tears remains controversial. Multiple treatment options have been proposed without any consensus.1, 16 Several factors may contribute to this lack of consensus. First, the definition of a “massive” tear has not yet been clearly standardized. Cofield et al6, 7 defined massive tears as >5 cm in either the anterior-posterior or medial-lateral dimension, whereas Gerber et al14 defined massive as a complete tear of at least 2 tendons. In the
Conclusions
This study suggests that dysfunction of the entire subscapularis or 3 rotator cuff muscles is a risk factor for pseudoparalysis. For function to be preserved in patients with massive chronic rotator cuff tears, it may be important to avoid fatty infiltration with anterior extension into the lower subscapularis tendon or involvement of more than 2 rotator cuff muscles.
Acknowledgment
Editorial assistance was provided by Mark English, PhD, of BellBird Editing.
Disclaimer
The authors, their immediate families, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.
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Cited by (0)
The Institutional Review Board of the ethical committee of the Hôpital Privé Jean Mermoz and the Centre Orthopédique Santy approved this study.