Arthroscopic rotator cuff repair in the weight-bearing shoulder

Background: In wheelchair-dependent individuals, pain often develops because of rotator cuff tendon failure and/or osteoarthritis of the glenohumeral joint. The purposes of this study were to investigate (1) specific rotator cuff tear patterns, (2) structural healing, and (3) clinical outcomes after arthroscopic rotator cuff repair in a cohort of wheelchair-dependent patients. Methods: Forty-six shoulders with a mean follow-up of 46 months (range, 24-82 months; SD, 13 months) from a consecutive series of 61 shoulders in 56 patients (46 men and 10 women) undergoing arthroscopic rotator cuff repair were available for analysis. Clinical outcome analysis was performed using the Constant-Murley score, the Subjective Shoulder Value, and the American Shoulder and Elbow Surgeons score. The integrity of the repair was analyzed by ultrasound. Results: Of the shoulders, 87% had supraspinatus involvement, 70% had subscapularis involvement, and 57% had an anterosuperior lesion involving both the supraspinatus and subscapularis. Despite an overall structural failure rate of 33%, the patients showed improvements in the Constant-Murley score from 50 points (range, 22-86 points; SD, 16 points) preoperatively to 80 points (range, 40-98 points; SD, 12 points) postoperatively and in the American Shoulder and Elbow Surgeons score from 56 points (range, 20-92 points; SD, 20 points) preoperatively to 92 points (range, 53-100 points; SD, 10 points) postoperatively, with a mean postoperative Subjective Shoulder Value of 84% (range, 25%-100%; SD, 17%). Conclusion: Failure of the rotator cuff in weight-bearing shoulders occurs primarily anterosuperiorly. Arthroscopic rotator cuff repair leads to a structural failure rate of 33% but satisfactory functional results with high patient satisfaction at midterm follow-up. (C) 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.