Revision Rotator Cuff Repair
Rotator cuff tears are a common shoulder problem. Rotator cuff repair provides good to excellent outcomes in most patients. However, a recurrent tear after repair surgery is not uncommon. Reasons for a failure of a rotator cuff repair include not just poor healing or retears, but other complications such as infection, and postoperative stiffness that leads to poor outcome. Persistent pain and loss of function after initial repair is an indication there may be a recurrent tear.
Function may be maintained despite a retear, but revision surgery is indicated when symptoms persistent 9-12 months after the initial repair, despite nonsurgical management. Failure may require revision surgery or tendon transfer, and if irreparable, reverse shoulder replacement.
What are the factors that impair tendon healing and affect retear rates?
- The risk of a retear increases with age. Studies report a significantly lower rate of healing in patients over the age 65.
- Tear size. Retears are more likely with larger tears.
- Tissue quality. The quality of the tendon and bone influence healing.
- A delay of rotator cuff repair longer than 12 months after diagnosis is associated with an increased risk of needing revision surgery.
- Bone mineral density is an independent predictor of healing after repair.
- BMI
- Stiffness
- Smoking and diabetes negatively affect tendon healing.
- Muscle atrophy and Patients with symptomatic failed rotator cuff repairs who have high grade degeneration of the muscle and dyslipidemia are at greater risk of retear after rotator cuff repair and revision repair.
When will revision surgery be recommended?
Careful analysis of these factors is essential to determine whether revision surgical repair should be recommended, and the type of repair needed. Dr. Godin will review your medical history, conduct an examination of shoulder function and order imaging studies with the goal of identifying the cause of a failed repair. He may suggest at trial of nonsurgical management. If symptoms fail to resolve revision surgery may be recommended.
Revision rotator cuff repairs
Favorable outcomes after revision surgery can be achieved with an open and arthroscopic surgery. Trends favor arthroscopic revision rotator cuff repair but both approaches provide reliable improvement in shoulder function, pain and patient satisfaction.
The type of revision surgery is determined by the type of tear and cause of symptoms, and may include re-suturing the tendon, tendon transfer, or joint replacement.
Revision surgery is more complex because repair has previously been performed. The good news is that retear rates decrease with surgical team expertise. Dr. Jonathan Godin is a shoulder expert trained at the world – renowned Steadman Clinic. His surgical expertise is unequaled.
Who is a good candidate for revision surgery?
Patient selection is important to optimize outcomes. Patient age and the number of torn tendons affect postoperative integrity. The main indicator of the need for revision rotator cuff repair is persistence of clinical symptoms despite nonsurgical management.
Arthroscopic rotator cuff revision surgery is best for young, healthy and active patients with a failed rotator cuff repair. Revision arthroscopic rotator cuff repair results in reliable pain relief and improvement in shoulder function in select cases. Post-op rehab is vital to the success of a revision rotator cuff repair.
Contact Dr. Jonathan Godin at Vail Orthopedic Surgery. He has offices in Vail, Frisco and Edwards Colorado. Don’t delay!
