High retear rates despite clinical improvement after arthroscopic partial repair for large to massive rotator cuff tears.

BACKGROUND: Management of large to massive rotator cuff tears (RCTs) remains challenging, particularly when complete anatomic repair is not feasible. The current study aims to evaluate short-term clinical outcomes and complications following arthroscopic partial repair of large to massive RCT with incomplete footprint coverage and to compare outcomes according to concomitant subscapularis repair and post-operative rotator cuff integrity.

METHODS: Patients who underwent arthroscopic partial repair of the supraspinatus tendon, with or without associated infraspinatus tears, and incomplete footprint coverage between July 2022 and April 2023 were retrospectively identified. Inclusion criteria included intraoperative confirmation of incomplete anatomic footprint coverage, an anteroposterior tear size ≥ 3 cm, and the presence of either an intact subscapularis tendon or a reparable concomitant subscapularis tear (Lafosse type ≤3). Patients were excluded if they were lost to follow-up, had a history of prior shoulder instability surgery, or had insufficient clinical or radiologic data. Clinical outcomes were evaluated pre-operatively and at final follow-up using the visual analog scale for pain, Constant score, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, active range of motion (ROM), and shoulder strength. Radiologic assessment included evaluation of repair integrity, acromiohumeral distance, and progression of glenohumeral arthritis.

RESULTS: After excluding 15 patients, 142 patients were included in the final analysis. At a mean follow-up of 26.2 months, significant improvements were observed in all pain, patient-reported outcome measures, ROM, and strength (all P < .001). Post-operative retear was identified in 43 patients (30.3%). Clinical outcomes did not differ significantly between patients with intact subscapularis tendons and those who underwent concomitant subscapularis repair. However, patients with intact post-operative repair integrity demonstrated significantly superior pain relief, functional scores, ROM, and strength compared with those who experienced retears (all P < .001).

CONCLUSION: Arthroscopic partial repair with incomplete footprint coverage was associated with significant short-term improvements in pain, function, ROM, and strength in patients with large to massive RCT. Outcomes were similar between patients with intact subscapularis tendons and those undergoing concomitant repair of reparable subscapularis tears. However, post-operative structural failure occurred in 30.3% of patients and was associated with inferior outcomes and frequent revision surgery. These findings should be interpreted cautiously given the retrospective design, absence of a comparator group, and short-term follow-up.