Unrepaired rotator cuff tears following acromioplasty
Background: The natural history of rotator cuff tears suggests that not all tears progress and small isolated rotator cuff tears might heal. To date there have been no long-term studies assessing the MRI changes of unrepaired full thickness supraspinatus tears after acromioplasty.
Methods: A database of patients from a single surgeon that have had acromioplasty without rotator cuff repair in the last five to 15 years was reviewed. The number of shoulders examined in this study was 17. Patients all completed an Oxford score, Constant score and had an MRI to assess fatty infiltration and atrophy.
Results: Mean follow-up time 7.2 years (range, 5–13 years). The patients were divided into three groups depending on the size of the tear at time of surgery: C1 tears (<1 cm) n=5, C2 tears (1–1.9 cm) n=8, C3 tears (2–3 cm) n=4. In the C2 group, MRI evaluation showed there were two patients that had tears that had regressed in size (CI 1.4–36, 4). In the C3 group, MRI evaluation revealed that all (100%) of the rotator cuff tears had significant fatty infiltration and atrophy. There was no statistical difference between groups when assessing Oxford scores (p=0.75) and Constant scores (p=0.69). There was significant association between increase in tear size and fatty infiltration (p=0.028). A possible association was noted between increase in tear size and atrophy (p=0.054).
Conclusion: Patients had good long-term clinical outcomes irrespective of tear size. It showed that not all tears progressed to significant fatty change and atrophy.
Level of evidence: Level 3