Sin ttulo de diapositiva

Massive Rotator Cuff Tear Surgical Technique and Results in Relations with Preoperative Prognostic FactorsDr. Fernando Barclay, Dr. Francisco Arcuri, Dr. Jorge Cavallo, Dr. Javier LeundaBuenos Aires, ArgentinaDisclosureArthrex2HypothesisThe results of arthroscopic repair of massive rotator cuff tears have a direct correlation with preoperative prognostic factors: Age, Chronicity, Retraction, Muscle Atrophy and Fatty Infiltration. 3 22 Shoulders/Arthroscopic massive rotator cuff repairSex 11/11 Age: 51-78 years 66.5 Symptoms: 2-84 month 20.3 Follow up: 24-96 month

Functional outcome: # Constant Score # Satisfaction Anatomical outcome: 16 with/ MRI

Materials and Methods Functional OutcomesConstant54,5%32%9%4,5%12 Shoulders7Shoulders2Shoulders1Shoulders Absolute Difference NMeanStd. DeviationSig. (2-tailed p)Constant pos-pre2235.912.15< 0.001Pain pos-pre224.94.13< 0.001Activivity pos-pre225.03.23< 0.001ROM pos-pre2218.47.00< 0.001Strenght pos-pre225.95.41< 0.001 % relative difference (**)NMean (%)Std. Deviation (%)Sig. (2-tailed)Constant pos-pre2284.328.73< 0.001Pain pos-pre2295.081.00< 0.001Activity pos-pre2253.237.40< 0.001ROM pos-pre22102.255.41< 0.001Strenght pos-pre2278. 878.03< 0.001Constant/Age/ChronicityP= -.321 No SignificantConstant pos-preAGEPearson CorrelationConstant pos-pre-.321AGE-.321Sig. (1-tailed)Constant pos-pre.073AGE.073N2222Constant pos-preCronicity (month)Pearson CorrelationConstant pos-pre-.442Chronicity (month)-.442Sig. (1-tailed)Constant pos-pre.020Chronicity (month).020.N2222P= -.442 SignificantAGECHRONICITYConstant/Retraction NMeanLtd. Deviation95% Confidence Interval for Mean Lower BoundUpper Bound21188.22519.844874.893101.5573693.53922.923169.483117.5964275.61017.2465-79.344230.5635357.01860.8307-94.094208.129Total2284.27228.726571.53697.009 Retractionp=0.308 No Significant (ANOVA)Tomazeau ClassificationConstant88%93,5%75,5%57%

Constant/AtrophyConstant91,5%106,5%84,5%50% NMeanStd. Deviation95% Confidence Interval for Mean Lower BoundUpper Bound0 no391.69321.628037.966145.4201 leve5106.59815.342387.548125.6482 moderada1084.47021.267069.25699.6833 severa450.30537.0081-8.583109.193Total2284.27228.726571.53697.009Atrophyp=0.018 Significant (ANOVA)Warners Classification

Constant/Fatty InfiltrationConstant98%100,5%82%78,5%67% NMeanStd. Deviation95% Confidence Interval for Mean Lower BoundUpper Bound0297.95626.4609-139.786335.69817100.40816.726384.939115.8772182.222...3678.46925.225251.997104.9414667.03138.941426.164107.897Total2284.27228.726571.53697.009Fatty Infiltrationp=0.291 No Significant(ANOVA) 16 MRI20.5%Re-ruptures Healing

4 years follow-upRe-ruptureHealedConstant/Healing/Re-ruptureConstant96%67,5%Healing p=0.065 No SignificantConstant2 Shoulders10 ShouldersRe-rupturep=0.715 No Significant91,5%86,5%4Shoulders12 Shoulders(ANOVA) Conclusions Arthroscopic repair of Massive Rotator Cuff Tears, could achieve acceptable and predictable results, only if a judicious surgical technique is done and preoperative Prognostic Factors are taking into account in the decision making. Muscle Atrophy and Chronicity of the tear affect postoperative functional results.Bibliography1. Alexander OM. Radiograph of the acromio clavicular articulation. Med Radiogr Photogr.1954;30-4.2. Bigliani LU, Cordasco FA, Mclveen ES. Operative repair of massive rotator cuff tears: Long term results; J Shoulder Elbow Surg. 1990; 1:120-303. Burckhart SS. Current Concepts: A stepwise approach tu arthroscopic rotator cuff repair based on biomechanical principles. Athroscopy 2000;6:82-90.4. Burckhart S. Athroscopic treatment of massive rotator cuff tears. Cl Orthop Related Surg. 1990:45-56.5. Codman EA. The shoulder: Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston: Miller; 1934. p. 243-5.6. Constant CR, Murley AMG. A clinical method of functional assessment of the shoulder. Clean Orthop 1987;214:160-4.7. De Palma AF. Surgery of the shoulder. Philadelphia: JB Lippincott; 1983. p. 260-8.8. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. JBJS 1999;8:599-605.9. Gerber C, Fuchs B, Hodler J. the results of repair of massive tears of the rotator cuff. JBJS. 2000;82:505-15.10. Lupo R, Benazzo F, Finardi E, Rapisarda S. Surgery in massive ruptures of the rotators cuff: results as related to prognosis. Chir. Organi Mov 2000;85:395-402.11. McLaughlin HL. Lesions of musculotendinous cuff of the shoulder. The exposure and treatment of tears with retraction. J BJS 1944; 26:31-51.12. Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. JBJS. 1972; 4/A:41-50. 13. Packer ENP, Calvert PT, Bayley JI. Operative treatment of chronic ruptures of the rotator cuff of the shoulder. JBJS. 1983;65:171-5.14. Patte. D. Classification of rotator cuff lesions. Clean Orthop. 1990;254:81-6.15. Pollock RG, Flatow EL. The rotator cuff. Full thickness tears. Mini-open repair. Orthop Clean North Am. 1997;28:169-77. 16. Rockwood C.A, Jr. The management of patients with massive defects in the rotator cuff. presidential guest speaker address. Mid-Americ Orthopedic Association, Orlando, Florida, Apr. 2-6, 1986.17. Sher JS, Iannotti JP, Warner JJ. Surgical treatment of post operative deltoid origin disruption. Clean Orthop Relat Res. 1997;343:93-8.18. Tashjian R, Levanthal B S, Spenciner D, Green A, Fleming C. Initial Fixation Strength of Massive Rotator Cuff Tears: In vitro Comparision of Single-Row suture anchor and Transosseous Tunnel Contructs. Arthroscopy 2007, pp 710-6.19. Tauro JC. Arthroscopic interval slide the repair of large rotator cuff tears. Arthroscopy 1999;15:527-30..