All right, I'd like to thank Anna for the invitation to talk, and also my co-authors for their help with this project. We have no financial disclosures related to this study, and a full list of disclosures is found on the Academy website. So rotator cuff tears are a common problem that greatly range in severity. Flat tears include those full thickness tears of two tendons, or a tear defect area greater than 30 square centimeters. These can be particularly challenging to deal with, as they're often associated with fatty atrophy, retraction, and poor tissue quality. However, as we've learned more about the biomechanical properties of the rotator cuff, our repair techniques and surgical strategies have changed. Effective management is often controversial, with treatment options spanning from simple debridement to reverse shoulder arthroplasty. In 1994, Dr. Burghardt first coined the term functional cuff repair, which is the idea that the cuff may be anatomically deficient, however biomechanically intact. He used the comparison of the rotator cable to a suspension bridge, and how force is transferred across the rotator cuff. The goal of a partial repair is to balance the anterior and posterior cuff to restore the transverse plane force couple, and thus stabilize the glenohumeral joint fulcrum. He concluded that tear location may be more important than tear size when deciding treatment for rotator cuff tears. The purpose of this study was to determine the significance of initial and residual tear defect size on the need for revision surgery in a group of patients with partial repair of massive rotator cuff tear. This was a retrospective study looking at a consecutive series of arthroscopic rotator cuff repairs done by a single surgeon between 2013 and 2016. 38 of 1954 patients were found to have massive tears, which we defined as greater than 30 square centimeters, that had partial rotator cuff repair, and were thus included. The mean age was 66 years old, and the average follow-up was four years, with a minimum of two-year follow-up. The partial repair was achieved in all patients using one to three suture anchors, with releases as needed. Tears were measured at the index operation using a calibrated probe to document tear size in both medial to lateral, as well as anterior to posterior plane, as demonstrated in the pictures on the right. They were then measured after repair using the same device. This gave us an objective way to accurately and consistently quantify our tear size. Post-operatively, patients were immobilized in an abduction pillow for two to six weeks with physical therapy started on an individualized basis. Of these patients, only two of the 38 required revision surgery at an average follow-up of four years. One patient had a revision rotator cuff repair after a fall, and another was converted to a reverse. Three of the 38 patients required some additional non-operative treatment in the form of steroid injection and physical therapy after initially being released from care, and the remaining 87% or 33 patients required no additional treatment during the course of the study. There's no correlation between residual tear defect size and the necessity for subsequent surgery. In fact, the only statistically significant finding was a larger residual defect size in those patients requiring additional non-operative treatment after initial release. So only 5% of patients required subsequent surgical intervention at an average follow-up of four years. The strengths of the study are this is a consecutive series of arthroscopic cuff repairs performed by a single surgeon using a consistent repair technique. Also the technique we used to measure defect size was felt to be advantageous because it allowed for an easy, accurate, and reproducible objective measurement of the initial and residual defect size in square centimeters. The main weakness of the study is the retrospective design. Our institution and senior authors previously published on their experience with partial repair massive cuff tears using similar measuring technique and demonstrated the effectiveness of partial repair with no difference in outcome scores between partial and complete repair. So in conclusion, there's no correlation between residual defect size after partial repair and the need for revision surgery. Patients who returned for additional non-op treatment were noted to have statistically larger residual defect size, and only 5% of patients underwent subsequent surgery at four years of four-year follow-up, suggesting that partial repair of massive cuff tears can provide a durable joint-preserving intervention while saving options for salvage surgery for the future if necessary. Thank you.

rotator cuff tears

partial repair

massive tears

biomechanical understanding

surgical strategies