Comparison of conservative and operative treatments of massive rotator cuff tears.

The results of conservative and operative treatment of massive rotator cuff tears were compared. All 9 men and 5 women who were treated conservatively (group I) had a Hamada Gpoup 4 arthrographic tear. The mean follow-up period was 4 years. The operative group (group II) was composed of 23 men and 3 women who had cuff tears of more than 5.0 cm in longest dimension. The mean age range at surgery was 62 years. Following anterior acromioplasty (n = 26), additional procedures included tenorrhaphy (n = 12), fascial grafting (n = 8), laterl transfer of the long head of the biceps brachii tendon (n = 2), muscle transfer of the teres minor (n = 3), muscle transfer of the supraspinatus (n = 1). The mean follow-up period was 4 years. The results were assessed using the Japanese Orthopaedic Association score. The JOA score was increased from 53.2 to 71.1 in group I, and from 58.8 to 85.9 in group II. More improvement in painrelief, muscle strength, and range of motion was obtained in group II than in group I. There was a significantly better final result in the patients without rupture of the tendon of the long head of the biceps brachii muscle.