Improved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior L-shaped rotator cuff tears
Abstract Purpose The treatment of massive anterior L-shaped rotator cuff tears (RCTs) remains challenging. This study focused on restoration of humeral head coverage by superiorly repositioning the rotator interval tissue. The study aimed (1) to present the short-term clinical and radiological outco...
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BMC
2025-06-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05975-x |
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| author | Yu-Sheng Chen Fa-Chuan Kuan Wei-Ren Su Chih-Kai Hong Yueh Chen Kai-Lan Hsu |
| author_facet | Yu-Sheng Chen Fa-Chuan Kuan Wei-Ren Su Chih-Kai Hong Yueh Chen Kai-Lan Hsu |
| author_sort | Yu-Sheng Chen |
| collection | DOAJ |
| description | Abstract Purpose The treatment of massive anterior L-shaped rotator cuff tears (RCTs) remains challenging. This study focused on restoration of humeral head coverage by superiorly repositioning the rotator interval tissue. The study aimed (1) to present the short-term clinical and radiological outcomes of arthroscopic partial repair combined with rotator interval shift and (2) to identify risk factors associated with failure in restoring superior humeral head coverage. Method A retrospective review was conducted on arthroscopic rotator cuff repairs performed by a single surgeon between January 2018 and December 2022. Patients with irreparable anterior L-shaped tears who underwent partial repair and rotator interval shift and had a follow-up of 2 years were included. The measured outcomes included range of motion, pain, and functional scores. Humeral head coverage was evaluated using magnetic resonance imaging (MRI) at 6 months postoperation, and patients were classified as either healed or having a retear. Logistic regression analysis was conducted to identify factors associated with retears. Results The study included 45 patients (19 men and 26 women) with an average age of 66.53 ± 6.70 years. After 2 years, significant improvements were observed in forward elevation (from 77.73 ± 40.96 to 156.11 ± 25.89), abduction (from 82.89 ± 43.78 to 161.33 ± 22.90), American Shoulder and Elbow Surgeons scores (from 43.24 ± 15.77 to 83.16 ± 10.27), and Constant–Murley scores (from 44.98 ± 15.76 to 86.38 ± 10.02; all p < 0.001). Visual analog scale pain scores also decreased (from 7.09 ± 2.35 to 1.29 ± 1.70). MRI results at 6 months showed that 30 of 45 patients (66.7%) had healed, while the retear rate was 33.3%. The acromiohumeral interval (AHI) was identified as the only factor significantly associated with retear. The odds ratio for predicting retear in patients with a preoperative AHI of < 5.0 mm was 5.50. (95% CI: 1.43–21.10, p = 0.013). Conclusion Arthroscopic partial repair combined with rotator interval shift is an effective treatment option for irreparable anterior L-shaped RCTs, demonstrating favorable short-term clinical and radiological outcomes. However, patients with a preoperative AHI of less than 5 mm are at greater risk of retear, potentially leading to reduced postoperative range of motion. Level of evidence Level IV, case series. |
| format | Article |
| id | doaj-art-a3483bf9039f4bcaabf6d95d20d78bfb |
| institution | OA Journals |
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| publishDate | 2025-06-01 |
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| spelling | doaj-art-a3483bf9039f4bcaabf6d95d20d78bfb2025-08-20T02:30:42ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-06-0120111310.1186/s13018-025-05975-xImproved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior L-shaped rotator cuff tearsYu-Sheng Chen0Fa-Chuan Kuan1Wei-Ren Su2Chih-Kai Hong3Yueh Chen4Kai-Lan Hsu5Department of Orthopedics, Taipei Municipal Hospital YangMing BranchDepartment of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Orthopedics, Kaohsiung Veterans General Hospital Tainan BranchDepartment of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityAbstract Purpose The treatment of massive anterior L-shaped rotator cuff tears (RCTs) remains challenging. This study focused on restoration of humeral head coverage by superiorly repositioning the rotator interval tissue. The study aimed (1) to present the short-term clinical and radiological outcomes of arthroscopic partial repair combined with rotator interval shift and (2) to identify risk factors associated with failure in restoring superior humeral head coverage. Method A retrospective review was conducted on arthroscopic rotator cuff repairs performed by a single surgeon between January 2018 and December 2022. Patients with irreparable anterior L-shaped tears who underwent partial repair and rotator interval shift and had a follow-up of 2 years were included. The measured outcomes included range of motion, pain, and functional scores. Humeral head coverage was evaluated using magnetic resonance imaging (MRI) at 6 months postoperation, and patients were classified as either healed or having a retear. Logistic regression analysis was conducted to identify factors associated with retears. Results The study included 45 patients (19 men and 26 women) with an average age of 66.53 ± 6.70 years. After 2 years, significant improvements were observed in forward elevation (from 77.73 ± 40.96 to 156.11 ± 25.89), abduction (from 82.89 ± 43.78 to 161.33 ± 22.90), American Shoulder and Elbow Surgeons scores (from 43.24 ± 15.77 to 83.16 ± 10.27), and Constant–Murley scores (from 44.98 ± 15.76 to 86.38 ± 10.02; all p < 0.001). Visual analog scale pain scores also decreased (from 7.09 ± 2.35 to 1.29 ± 1.70). MRI results at 6 months showed that 30 of 45 patients (66.7%) had healed, while the retear rate was 33.3%. The acromiohumeral interval (AHI) was identified as the only factor significantly associated with retear. The odds ratio for predicting retear in patients with a preoperative AHI of < 5.0 mm was 5.50. (95% CI: 1.43–21.10, p = 0.013). Conclusion Arthroscopic partial repair combined with rotator interval shift is an effective treatment option for irreparable anterior L-shaped RCTs, demonstrating favorable short-term clinical and radiological outcomes. However, patients with a preoperative AHI of less than 5 mm are at greater risk of retear, potentially leading to reduced postoperative range of motion. Level of evidence Level IV, case series.https://doi.org/10.1186/s13018-025-05975-xRotator cuff tearMassiveIrreparableL-shapedRotator cuff repairRotator interval |
| spellingShingle | Yu-Sheng Chen Fa-Chuan Kuan Wei-Ren Su Chih-Kai Hong Yueh Chen Kai-Lan Hsu Improved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior L-shaped rotator cuff tears Journal of Orthopaedic Surgery and Research Rotator cuff tear Massive Irreparable L-shaped Rotator cuff repair Rotator interval |
| title | Improved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior L-shaped rotator cuff tears |
| title_full | Improved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior L-shaped rotator cuff tears |
| title_fullStr | Improved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior L-shaped rotator cuff tears |
| title_full_unstemmed | Improved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior L-shaped rotator cuff tears |
| title_short | Improved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior L-shaped rotator cuff tears |
| title_sort | improved clinical outcomes after arthroscopic partial rotator cuff repair with rotator interval shift for the treatment of massive irreparable anterior l shaped rotator cuff tears |
| topic | Rotator cuff tear Massive Irreparable L-shaped Rotator cuff repair Rotator interval |
| url | https://doi.org/10.1186/s13018-025-05975-x |
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