Primary arthroscopic rotator cuff repair reversed preoperative pseudoparalysis

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ORLANDO – Primary arthroscopic rotator cuff repair for massive tears reversed pseudoparalysis, according to a presenter at the Arthroscopy Association of North America Annual Meeting, here.

“Massive rotator cuff tears are involved in 20% of primary tears and 80% of recurrent tears that are repaired arthroscopically,” Patrick Denard, MD, said. “These [tears] can be associated with pseudoparalysis or the inability to raise the arm above 90° forward flexion in association with full passive forward elevation. This is due to disruption of balanced force couples particularly in association of rotator cables and also has been shown to be related to subscapularis tears as reported at this year’s Academy meeting. One can surmise that repair may lead to restoration of forward flexion.”

Denard and his colleagues measured the functional results after arthroscopic rotator cuff repair of patients with preoperative pseudoparalysis. Denard said he and his colleagues hypothesized primary repair would “more predictably restore forward flexion than revision repair.”

Patrick Denard, MD
Patrick Denard

The researchers constructed a 10-year retrospective review. The only inclusion criterion was massive tears repaired by arthroscopic surgery. Exclusion criteria were shoulder instability, passive restriction and preoperative nerve injury. The patient cohort was divided into two groups – a primary group of 165 tears of which 39 patients had pseudoparalysis and a revision group with 63 tears of which 14 patients had pseudoparalysis. The average age of the primary group was 62 years and had pseudoparalysis for 4.5 months. Average follow-up was 75 months. The revision group had a mean of 1.4 surgeries prior to arthroscopic rotator cuff repair.

Forward flexion was restored in 90% of patients in the primary group compared to 42% in the revision group. The primary group also showed improvement of functional outcome compared to the revision group. Patients who had pseudoparalyis for a shorter time and patients who had complete repair (97%) were more likely to recover than patients who were neither (63%).

“Primary arthroscopic rotator cuff repair can lead to reversal of preoperative pseudoparalysis with a low complication rate,” Denard said. “However, in the setting of revision repair for pseudoparalysis patients, only 42% of those gained forward flexion above 90°.”

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