Clinical Outcomes at a Minimum 20 Years Following Arthroscopic Repair of Massive Rotator Cuff Tears

DOI: 10.70885/hmsj.2026.09.002

Abstract

Background: Massive rotator cuff tears (MRCTs) are technically challenging rotator cuff tears to repair and have a high risk of recurrence. Although favorable short- and mid-term outcomes have been reported after arthroscopic repair, very long-term outcomes remain poorly defined, with available 20-year data derived primarily from open repair cohorts.Hypothesis: We hypothesized that, similar to extended long-term outcomes after open rotator cuff repair, arthroscopic repair would provide durable improvement in pain and patient-reported function at minimum 20-year follow-up compared to preoperative and mid-term follow-up evaluations.Methods: A retrospective case series of patients who underwent primary arthroscopic repair of massive rotator cuff tears by a single surgeon between 1998 and 2005. Massive tears involved ≥2 tendons or measured ≥5 cm, confirmed intraoperatively. Patients with revision, open, or irreparable tears, or incomplete follow-up data were excluded. ASES score, Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), VAS pain, range of motion, and reoperation rates were assessed at mid-term and long-term follow-up.Results: Of 126 eligible patients, 14 were available for minimum 20-year clinical follow-up (mean age 55.8 ± 8.5 years). Mean follow-up was 92.6 ± 28.0 months (mid-term) and 266.9 ± 28.1 months (long-term). ASES improved from 50.4 ± 19.3 preoperatively to 94.8 ± 6.4 at mid-term and 84.4 ± 12.5 at long-term (p = .004), with a significant mid- to long-term decline (p = .04). VAS improved from 5.7 ± 2.5 to 0.3 ± 0.9 at mid-term and 1.3 ± 1.9 at long-term (p < .001 for both). SSV improved from 42.3 ± 19.4 to 94.0 ± 4.6 at mid-term and 84.2 ± 16.7 at long-term (p < .001; mid- to long-term p = .09). Mean SST was 76.9 ± 21.8 at long-term. Forward flexion improved from 126.9° ± 50.2° to 164.6° ± 27.9° at long-term (p = .03). Twelve patients (86%) returned to sport and no patients required reoperation.Conclusion: Among patients available for evaluation at a minimum of 20 years, improvements in pain and patient-reported function were maintained compared with preoperative values, although some decline was noted between mid-term and long-term follow-up evaluations. No included patients underwent reoperation.What this study adds to existing knowledge: Among patients available for minimum 20-year follow-up, improvements in pain and patient-reported function after arthroscopic repair of massive rotator cuff tears remained greater than preoperative levels.How this study might affect research, practice, or policy: These findings provide preliminary very long-term data that may inform future larger studies evaluating the durability of arthroscopic repair of massive rotator cuff tears.Study Design: Retrospective Case SeriesLevel of Evidence: IVKeywords: Massive rotator cuff tear; Arthroscopic rotator cuff repair; Long-term outcomes; Shoulder arthroscopy; Patient-reported outcomeshttps://doi.org/10.70885/hmsj.2026.09.002

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