O2163 RECURRENT ANTERIOR SHOULDER INSTABILITY CAUSED BY MASSIVE ROTATOR CUFF TEARS

Abstract

Aim: The common cause for recurrent instability in older patients, is the massive tear of the rotator cuff tendons. This paper presents the results of the operative treatment for the above-mentioned rare and complex lesion. Method: Seven (7) patients, three (3) male and four (4) female with a mean age of 71 years developed recurrent shoulder instability as a result of trauma or preceding infection, which destroyed the rotator cuff. All cases presented with instability, pain and weakness, and in 2 cases the subluxation was obvious in every attempt to raise the arm. All of the patients had tears in at least two tendons of the rotator cuff. The cases were treated operatively with a combination of the Boytchev anterior stabilization procedure with an attempt to close the rotator cuff tear. A complete closure was achieved in 3 cases, and a partial closure in 2. In the remaining 2 cases the closure of the tear was impossible. All of the patients postoperatively underwent an early mobilization regime. Results: The mean follow-up was 30 months. Stabilization of the shoulder was achieved in 6 cases. Constant score varied from 50 to 85. One patient had a recurrent of the subluxation. All of the patients presented marked improvement in pain and in muscle strength. Two (2) of them developed almost full range of motion and satisfactory muscle strength. Four (4) patients presented decreased range of motion and muscle strength 50% of the unaffected arm, while one patient developed inability to raise his arm above 70 degrees. Conclusions: The combination of recurrent anterior instability with massive rotator cuff tears presents great difþculty in treatment especially in the cases where an infection had preceded. A complete closure of the rotator cuff tear is usually very difþcult to achieve.