Analysis of failed rotator cuff repair – Retrospective survey of revisions after open rotator cuff repair
Rupert Schupfner, Christian Haag, Lothar Veits
Abstract
Background
Rotator cuff defects are frequently occurring shoulder pathologies associated with pain and movement impairment.
Aims
The aim of the study was to analyse the pathologies that lead to operative revisions after primary open rotator cuff repair.
Methods
In 216 patients who underwent primary rotator cuff repair and later required operative revision between 1996 to 2005, pathologies found intraoperatively during the primary operation and during revision surgery were collected, analysed and compared.
Results
The average age at the time of revision surgery was 54.3 years. The right shoulder (61.6 per cent) was more often affected than the left, males (63.4 per cent) more often than females. At primary operation – apart from rotator cuff repair – there were the following surgical procedures performed: 190 acromioplasty, 86 Acromiclavicular joint resections, 68 tenodesis, 40 adhesiolysis and 1 tenotomy. If an ACJ-resection had been performed in the primary operation, ACJ-problems were rare in revision surgery (p < 0.01). Primary gleno-humeral adhesions were associated with a significant rise in re-tearing rate (p=0.049). Primary absence of adhesions went along with a significant lower rate of adhesions found at revision (p=0.018). Primary performed acromioplasty had no influence on re-tearing rate (p=0.408) or on the rate of subacromial impingement at revision surgery (p=0.709).
Conclusion
To avoid operative revision after rotator cuff repair relevant copathologies of the shoulder have to be identified before or during operation and treated accordingly. Therefore, even during open rotator cuff repair, the surgeon should initially start with arthroscopy of the shoulder joint and subacromial space to recognise co-pathologies.
Full Text:
Rotator cuff defects are frequently occurring shoulder pathologies associated with pain and movement impairment.
Aims
The aim of the study was to analyse the pathologies that lead to operative revisions after primary open rotator cuff repair.
Methods
In 216 patients who underwent primary rotator cuff repair and later required operative revision between 1996 to 2005, pathologies found intraoperatively during the primary operation and during revision surgery were collected, analysed and compared.
Results
The average age at the time of revision surgery was 54.3 years. The right shoulder (61.6 per cent) was more often affected than the left, males (63.4 per cent) more often than females. At primary operation – apart from rotator cuff repair – there were the following surgical procedures performed: 190 acromioplasty, 86 Acromiclavicular joint resections, 68 tenodesis, 40 adhesiolysis and 1 tenotomy. If an ACJ-resection had been performed in the primary operation, ACJ-problems were rare in revision surgery (p < 0.01). Primary gleno-humeral adhesions were associated with a significant rise in re-tearing rate (p=0.049). Primary absence of adhesions went along with a significant lower rate of adhesions found at revision (p=0.018). Primary performed acromioplasty had no influence on re-tearing rate (p=0.408) or on the rate of subacromial impingement at revision surgery (p=0.709).
Conclusion
To avoid operative revision after rotator cuff repair relevant copathologies of the shoulder have to be identified before or during operation and treated accordingly. Therefore, even during open rotator cuff repair, the surgeon should initially start with arthroscopy of the shoulder joint and subacromial space to recognise co-pathologies.
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