Comparison Of The Curative Effects Of Three Surgical Methods Under Arthroscope In The Treatment Of Massive Rotator Cuff Tears

Background and Objective :Massive rotator cuff tears(m RCT)refers to rotator cuff tears involving more than two tendons or tear diameter greater than 5 cm,symptoms such as shoulder pain,limited mobility,and weakness can occur,which seriously affects the quality of patients' life.The traditional treatment of massive rotator cuff tear is mainly open surgery,but open surgery has many disadvantages,such as large trauma,long recovery period and high incidence of shoulder stiffness.With the continuous development of arthroscopic instruments and surgical techniques,the curative effect of arthroscopic treatment of massive rotator cuff tear is close to or even better than traditional open surgery and it has the advantages of small deltoid muscle injury,early functional exercise,low incidence of shoulder stiffness,and high satisfaction with early curative effect.Arthroscopic treatment of massive rotator cuff tears is divided into three types: arthroscopic debridement(Arthroscopic debridement,DB),partial repair(partial repair,PR)and complete repair(Complete repair,CR).The purpose of this study is to compare the efficacy of arthroscopic debridement DB,partial repair PR,and complete repair CR for massive rotator cuff tear m RCT based on functional parameters,subjective parameters,and repair integrity.Methods :A total of 68 shoulder joints with m RCT were included and treated with arthroscopic DB(n = 23),PR(n = 22)and CR(n = 23),respectively.Functional and subjective parameters were used to evaluate the treatment effect before and 45 months after surgery in all patients,and MRI was used to evaluate the form of preoperative tendon tear and postoperative repair integrity.We have established a coding system that accurately describes rotator cuff tear,treatment and retear.Results:(1)There was no significant difference in preoperative parameters of the patients except faftty degeneration.Compared with preoperative parameters,the postoperative indicators of the patients in the DB,PR and CR groups were significantly improved (P<0.01).(2)We compared the shoulder Constant-Murley score(CS)and quick Disability of Arm Shoulder and Hand score(q DASH)among the groups.Comparing the results of the postoperative groups,the scores of the arthroscopic debridement DB group(constant score,CS 65.8 ± 14.7,q DASH 24.1 ± 20.6)and the arthroscopic partial repair PR group(CS 68.5±10.6,P = ns;q DASH 21.2±9.5,P = ns)were similar,while Compared with arthroscopic partial repair group PR,arthroscopic complete repair group CR improved more significantly(CS 83.4±7.3 vs 68.5±10.6,P = 0.009;q DASH(5.4±8.3vs 21.2±9.5,P = 0.006).(3)Retear rates with CR(29 %)were lower compared to PR(53 %).The vast majority of patients were satisfied with their arthroscopic procedure(DB 87 %;PR 86%;CR 91 %).Conclusion:Arthroscopic DB,PR,and CR were effective in treating m RCT involving at least two tendons.Among them,CR is more effective in follow-up and the rate of retear is low.We recommend CR to treat massive rotator cuff tear if conditions permit.