Arthroscopic debridement of irreparable rotator cuff tears: predictors of failure and success

Hypothesis/Background: Many techniques have been described to treat irreparable rotator cuff tears (RCT). Arthroscopic debridement for massive, irreparable RCT has been previously described to be a successful operation. The primary objective of our study was to analyze the mid-term outcomes and failure rates of arthroscopic debridement for irreparable RCTs and identify risk factors associated with failure and poor outcomes. Methods: We retrospectively identified all patients between 2008 and 2013 who underwent arthroscopic debridement for an irreparable RCT. Demographics, operative reports, and preoperative imaging were collected from the medical record and outcome scores (American Shoulder and Elbow Surgeons [ASES] and visual analog scale) were collected at a minimum of 5-year follow-up. Results: Twenty-six patients were included with a median follow-up of 98 months (range, 58-115 months). The average age at the time of surgery was 60 +/- 11 years. Six patients (23%) had a reoperation at a median 11 months (range, 1-91 months), with 5 of those being revised to reverse shoulder arthroplasty. Median ASES and visual analog scale pain scores improved significantly from preoperatively to postoperatively (P < .01). Lower preoperative forward elevation was associated with worse postoperative ASES scores (P = .004) and revision to reverse shoulder arthroplasty. We found no associations between preoperative radiographic variables and reoperation or lower outcome scores. Discussion/Conclusion: Arthroscopic debridement for irreparable RCT shows good mid-term success with improvements in patient-reported outcome scores and pain. Cost-effectiveness of more expensive procedures should be considered in the context of these successful results. Poor preoperative forward elevation appears to be a negative predictor of outcome and should be considered carefully when indicating patients for this procedure. (C) 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.