J Sport Med 2002 May;12(3):151-7
Negative prognostic factors in managing massive rotator cuff tears.
Vad VB, Warren RF, Altchek DW, O'Brien SJ, Rose HA, Wickiewicz TL.
Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, U.S.A.
To investigate the negative prognostic factors in the management of massive
rotator cuff tears. DESIGN: Retrospective nonrandomized study. SETTING:
Faculty Practice associated with a major orthopedic teaching hospital.
PATIENTS: 108 patients who were treated for massive rotator cuff tears were
evaluated for an average of 3.2 years posttreatment. There were 58 females and
50 males, with a mean age of 61.3 years. INTERVENTIONS: 40 patients underwent
conservative nonsurgical management (Group 1), 32 patients underwent
arthroscopic debridement (Group 2), and 36 patients underwent primary repair
of the rotator cuff (Group 3). MAIN OUTCOME MEASURES: A detailed Shoulder
Rating Questionnaire was filled out by patients pretreatment and minimal 2
years posttreatment. RESULTS: Overall, Group 1 had 65% excellent or good
outcomes, Group 2 had 81%, and Group 3 had 86%. The subgroup of patients in
Group 1 who had cortisone injections had a 75% success rate. CONCLUSIONS:
Negative prognostic factors evaluated are presence of glenohumeral arthritis,
decreased passive range of motion, superior migration of the humeral head,
presence of atrophy, and external rotation/abduction strength less than 3. The
presence of 3 or more of these negative prognostic factors are correlated with
poor outcomes in the treatment of massive rotator cuff tears.