DECOMPRESSION FOR CUFF DEFECT, IS IT WORTH IT?

A prospective study to assess the long-term outcome of ASAD (arthroscopic subacromial decompression) in the presence of un-reconstructable large and massive cuff tears using a modified Constant score. All patients under the care of the senior author admitted for ASAD had a modified Constant score recorded pre-operatively, excluding the power component. Review of patient notes between May 1994 and August 2000 identified 40 patients (45 shoulders) with un-reconstructable rotator cuff tears found at the time of surgery. Nine patients failed to attend. Thirty-one patients (35 shoulders) were scored by a single independent observer. Five shoulders were excluded having undergone subsequent surgery. Five pre-operative scores could not be retrieved. The preoperative and review scores were compared in the remaining 25 patients (25 shoulders). The average age at review was 75 years (range 39–85) with mean review of 51 months from surgery (range 20–94). In the studied population the mean score increased as follows (95% confidence limits in parentheses). Mean pain score improved from 4.8 (+/−2) to 8.5 (+/−1.6), the mean activities of daily living score increased from 8.9 (+/−1.5) to 12.6 (+/−2.4) and the range of motion improved from 22.9 (+/−2.9) to 31.3 (+/−3.3) points. The total score improved from 36.6 (+/−4.6) to 52.4 (+/−6.5). The average gain for each patient was 15.8 (+/−6.5) The 95% confidence limits indicate significant improvement for pain, range of motion and total score. In our study population of patients undergoing ASAD in the presence of un-reconstructable cuff tears, the 95% confidence limits of the preoperative and follow up scores do not overlap. ASAD confers significant benefit in patients with large cuff defects.