Reconstruction of rotator cuff tears in wheelchair-bound paraplegic patients
These authors reported on 13 paraplegic patients (8 men and 5 women; 16 shoulders) who underwent rotator cuff repair.. The average age at the time of surgery was 48.7 years. The causes of paraplegia were poliomyelitis in 9 patients, spinal fracture in 4, and cerebral infarction in 2. Open rotator cuff repair was performed in 11 patients and arthroscopic repair in 2 patients.
After surgery, no wheelchair propulsion was allowed for 6 months postoperatively. The shoulders were assessed with the American Shoulder and Elbow Surgeons (ASES) score and Constant score as well as magnetic resonance imaging or ultrasonography at an average of 31.2 months (min 12 months) postoperatively.
After repair an abduction brace was used for two months. Patients were advised not to use the affected arm for leaning, wheelchair pushing or propulsion, for 6 months.
The retear rate was 12%. The functional scores were improved in the two patients with retears visual analog pain scales improved form 7 to 2 and from 8 to 2. ASES scores were 100 and 60 points and Constant scores were 99 and 60 points, respectively. These scores were essentially the same as those of patients with intact repairs.
Comment: Shoulder symptoms are very common in individuals with paraplegia. Often these are due either to cuff tendon failure or to degenerative arthritis related in large part to the need to use the arms for transfer, propulsion, and lifting their wheelchairs in and out of vehicles. Cuff tears have been reported in up to three-quarters of individuals with paraplegia.
This paper points out the tremendous morbidity inherent in protecting a cuff repair in an individual with paraplegia: one half year of loss of independence. This was a very small series, but the suggestion is that the results of the failed repairs were not obviously worse than those of repairs that remained intact. This brings up the question of the value of the heavily protective program.
Finally, the retear rate of 12% reported here is less than half that reported for ambulatory patients (27% retear rate in a recent review of the literature
), making one wonder if this figure is truly representative of the failure rate of repairs in individuals with paraplegia.