Surgical treatment of irreparable massive injuries of the rotator cuff of the shoulder joint

Abstract

Introduction Surgical treatment of massive non-repaired injuries of the rotator cuff of the shoulder (RCS) is associated with many difficulties for orthopedic traumatologists. Standard refixation is ineffective in these patients and there no any generally accepted treatment strategies. Therefore, there is a need to look for alternative methods of reconstruction. The aim of the study was to develop a new technique for the reconstruction of irreparable ruptures of the RCS, comparing its clinical effectiveness with the technique of partial reconstruction. Materials and methods The study included 58 patients with massive irreparable injuries of the RCS, who underwent arthroscopic reconstruction of the RCS in the time period from 2017 to 2020 at the FSBI "FCTA" of the Ministry of Health of Russia (Cheboksary). Thirty patients of group I (control group) underwent partial reconstruction of the cuff, and 28 patients of group II had reconstruction according to the technique developed by us. The essence is additional plasty of the rotators using tendon autograft from the long fibular muscle and the proximal biceps. The average follow-up period was 30.7 ± 5.6 months. The results were evaluated using the VAS, ASES, UCLA, CSS scales, X-ray and MRI data. Results Good and excellent results according to the UCLA-ASES-CSS scales were achieved in 53.6 % in patients of group II versus 26.7 % in patients of group I (p = 0.036). In group I, VAS was 2.1 ± 1.8 and in group II – 1.0 ± 1.1 (p = 0.02). The average value of the acromiohumeral interval was 6.7 ± 2.7 mm after using the modified RCS reconstruction technique, versus 3.6 ± 2.1 mm in the control group of patients (p < 0.0001). According to MRI data, the rate of full-layer repeated ruptures of the RCS tendons after reconstruction using the modified technique was significantly lower, 17.9 % versus 56.7 % in the group of partial reconstruction technique (p = 0.002). Four patients from group I underwent revision surgery, and two of them required arthroplasty with a reversible endoprosthesis due to the progression of arthritic changes in the shoulder joint. Conclusion The developed technique for reconstruction of ”irreparable" massive injuries of the RCS allows restoring vertical balance in the shoulder joint, significantly improves clinical and functional indicators, reduces the number of repeated ruptures of the rotator tendons in comparison with the method of partial reconstruction.

Keywords

• shoulder joint
• rotator cuff
• massive irreparable injury
• arthroscopic reconstruction
• autograft plastic surgery