ARTHROSCOPIC SUBACROMIAL SPACER IMPLANTATION PROVIDES RELIABLE PAIN AND FUNCTIONAL IMPROVEMENT IN PATIENTS WITH IRREPARABLE MASSIVE ROTATOR CUFF TEAR AT 20 MONTHS FOLLOW-UP: A UK BASED SINGLE CENTRE PROSPECTIVE STUDY

摘要

Purpose: Subacromial biodegradable spacer implantation has been reported to be an effective treatment for irreparable rotator cuff tear but the factors predictive of outcome had not been studied. We intend to report U.K. based patient experience and to study significant predictive factors. Method: We reviewed a prospectively collected database of 26 patients (mean age: 68; range: 48-88) who had undergone arthroscopic subacromial spacer implantation (mean follow-up: 20.5 months). Data was collected via telephone interview, questionnaire and clinical examination at 8 weeks, 6, 12 and 24 months post-op. Results: The mean post-operative Oxford Shoulder Score (OSS) is 31 (9-48). Nearly half (48%) of the patients reported >50% improvement in pain and function while 33% reported no improvement. Nearly two-thirds (64%) of patients reported that the surgery was worthwhile and would undergo the surgery again for the contra lateral shoulder. Eighty-five percent (22/26) of the patients had early grade 1 or 2 gleno-humeral joint arthritis; 42% (11/26) had a partial thickness upper border subscapularis tear; 50% had pre-operative abduction of over 90° and 65% had superior humeral head migration pre-operatively. Five patients had improvement in abduction while 3 deteriorated. The pre-operative superior humeral head migration remained unchanged post-operatively. Of those patients who had no improvement, 4 required reverse shoulder replacement and I had superior capsular reconstruction. There were no complications. Linear regression analysis showed that age, early arthritic changes, history of previous cuff repair, superior humeral head migration, bicep pathology, subscapularis tear, pre-operative abduction did not predict the final outcome (p > 0.05) although this may be due to type 1 error. Conclusion: Subacromial spacer implantation provides reliable short term pain and functional improvement. However, larger size prospective study is required to investigate the predictive factors and recommend selection criteria for patients who will benefit from this procedure as one third of patients in our series showed no improvement.