Negative prognostic factors in managing massive rotator cuff tears

Objective: To investigate the negative prognostic factors in the management of massive rotator cuff tears. Design: Retrospective nonrandomized study. Setting: Faculty Practice associated with a major orthopedic teaching hospital. Patients: 108 patients who were treated for massive rotator cuff tears were evaluated for an average of 3.2 years posttreatment. There were 58 females and 50 males, with a mean age of 61.3 years. Interventions: 40 patients underwent conservative nonsurgical management (Group 1), 32 patients underwent arthro scopic debridement (Group 2), and 36 patients underwent primary repair of the rotator cuff (Group 3). Main Outcome Measures: A detailed Shoulder Rating Questionnaire was filled out by patients pretreatment and minimal 2 years posttreatment. Results: Overall, Group 1 had 65% excellent or good outcomes, Group 2 had 81%, and Group 3 had 86%. The subgroup of patients in Group I who had cortisone injections had a 75% success rate. Conclusions: Negative prognostic factors evaluated are presence of glenohumeral arthritis, decreased passive range of motion,superior migration of the humeral head, presence of atrophy, and external rotation/abduction strength less than 3. The presence of 3 or more of these negative prognostic factors are correlated with poor outcomes in the treatment of massive rotator cuff tears.