Paper 49: Bridging Reconstruction for Large-to-Massive Rotator Cuff Tears Has a Low Rate of Cuff Arthropathy Progression at A Minimum Five-Year Follow-Up

OBJECTIVES: Rotator cuff tears cause pain, muscle weakness, and difficulty with overhead activity. While smaller tears are easier to repair, large-to-massive cuff tears (>3 cm in size) are considered irreparable. For patients with large-to-massive cuff tears, surgical options include maximal repair, superior capsular reconstruction, bridging reconstruction, tendon transfers and reverse total shoulder arthroplasty (rTSA). Bridging reconstruction was developed to improve outcomes and to avoid the morbidity associated with other technique. Bridging reconstruction, also known as graft interposition, has been shown to have superior outcomes as compared to maximal repair with better patient-reported outcomes at two-years post-operatively as recently demonstrated in a randomized controlled trial. These positive results are maintained at five years, however the midterm changes in progression of rotator cuff arthropathy and conversion to rTSA have not been assessed. The purpose is to assess the progression of rotator cuff arthropathy in bridging reconstruction patients at a five-year follow-up. METHODS: Forty-four patients who underwent bridging reconstruction between 2012 and 2017 for large-to-massive rotator cuff tears were included. All patients had a minimum five-year follow-up. Data collected included demographics, pre- and post-operative Western Ontario Rotator Cuff (WORC) Index, conversion to rTSA, and X-ray readings (including acromiohumeral distance (as measured on anterior-posterior pre/post-operative radiographs) and Hamada grades for rotator cuff arthropathy). Furthermore, a sub-group analysis was performed on post-operative MRIs for graft status. RESULTS: The mean age at surgery was 59.9± 10.8 years with a mean follow-up of 7.3±1.4 years. The population was mostly male (70.5%). Pre-operatively, seven patients had mild rotator cuff arthropathy with Hamada grade 2-3, and one patient had Hamada grade 4B. The rest of the patients had Hamada grade one preoperatively. At a minimum five-year postoperative follow-up, only one patient had a rTSA, resulting in a survivorship rate of 98%. Two patients (4.6%) had post-operative Hamada grade 4. One patient had progression of cuff arthropathy from pre-operative Hamada 3 to post-operative Hamada 4A. The other patient maintained Hamada grade 4B from pre-operative to post-operative. Patients with progression of cuff arthropathy (i.e. higher post-operative Hamada grade) appear to have a higher possibility of complete post-operative graft tears. [SS1] [JM2] There were no correlations between progression of cuff arthropathy and WORC score at five years. CONCLUSIONS: At a minimum 5-year with a mean follow-up of 7.3 years, bridging reconstruction showed 98% survivorship rate with a low rate of conversion to rTSA and a low progression of cuff arthropathy with only 4.6% of patients having advanced RCA with Hamada grade 4.