Description
Background
Degeneration of the coracoacromial ligament (CAL) frequently accompanies massive rotator cuff tears. The potential impact of CAL release and acromioplasty on retear rates and complications, such as iatrogenic shoulder instability, remains uncertain. This study aimed to assess the effects of CAL degeneration, postoperative retear incidence, and preoperative rotator cuff tear patterns on functional outcomes and residual pain following arthroscopic surgery.
Methods
We prospectively recruited 44 patients who had undergone arthroscopic rotator cuff repair without acromioplasty or CAL release. Preoperative MRI scans were reviewed to determine the patterns of rotator cuff tears. The CAL was biopsied intraoperatively and histologically analyzed using the Bonar score. The integrity of the repaired supraspinatus tendon was analyzed on follow-up MRI at six months postoperatively using the Sugaya classification. Finally, the functional outcomes including ASES score, Constant-Murley score, and VAS for pain were followed up every 3 months until 1 year after surgery. The differences in outcomes were analyzed using repeated-measure ANOVA.
Results
Twenty five out of the 44 patients completed one-year follow up. Compared with those with mildly degenerated CAL, patients with moderate to severe CAL degeneration had equivalent ASES and Constant score (p=0.127 and p=0.417) but significantly higher residual pain (p=0.046). Patients with retear on MRI images, shown as insufficient thickness of repaired supraspinatus tendon 6 months after surgery, also had equivalent ASES and Constant score (p=0.109 and p=0.404) but significantly higher residual pain (p=0.010). In contrast, preoperative tear pattern defined by Collin classification did not affect functional outcomes or postoperative pain.
Conclusion
In massive rotator cuff tears, postoperative functional outcomes were primarily influenced by retear incidence. While CAL degeneration correlated with slightly increased residual pain, it did not reach minimal clinically significant difference. Preoperative tear patterns had no significant impact on outcomes. Clinically, retaining a degenerated CAL might lead to minor residual pain without compromising functional recovery, whereas CAL release could potentially result in iatrogenic shoulder instability. Shared preoperative decision-making is recommended when considering concomitant acromioplasty during arthroscopic repair of massive rotator cuff tears.
