Revision Rotator Cuff Repair: Factors Influencing Results

• Published in: Journal of bone and joint surgery. American volume Vol. 83; no. 12; pp. 1849 - 1855
• Main Authors: Djurasovic, Mladen, Marra, Guido, Arroyo, Julian S, Pollock, Roger G, Flatow, Evan L, Bigliani, Louis U
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01.12.2001; Journal of Bone and Joint Surgery Incorporated; Journal of Bone and Joint Surgery AMERICAN VOLUME
• Edition: American volume
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Reoperation - statistics & numerical data; Rotator Cuff - surgery; Rotator Cuff Injuries; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Juxtaarticular disease; Human; Reoperation; Prognosis; Indication; Diseases of the osteoarticular system; Plasty; Orthopedic surgery; Treatment; Revision; Surgery; Shoulder; Acromion; Tissue rupture; Thoracic girdle; Technique; Predictive factor; Rotator cuff
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200112000-00013

BackgroundRevision rotator cuff repair is a surgical challenge, and the results have generally been inferior to those of primary repair. We examined the results of revision rotator cuff repair in a large series of patients and assessed which subgroups of patients had the greatest chance for a satisfactory functional outcome.MethodsA revision rotator cuff repair was performed in eighty patients after the failure of a previous operative repair. The average age of the patients at the time of the revision was fifty-nine years. Prior to revision, the average pain score was 7.4 points (with 0 points indicating no pain and 10 points, severe pain) and the active range of motion of the shoulder averaged 105° of elevation, 39° of external rotation, and internal rotation to the eleventh thoracic vertebra. All patients underwent repeat repair of the rotator cuff tendons to bone. Additional procedures included revision acromioplasty (fifty-three patients; 66%) and distal clavicular excision (twenty-six patients; 33%), among others.ResultsAfter an average duration of follow-up of forty-nine months, the result was rated as satisfactory (excellent, good, or fair) in fifty-five patients (69%) and as unsatisfactory (poor) in twenty-five (31%). At the time of the latest follow-up, the average pain score had improved to 3.0 points and the active range of motion averaged 130° of elevation, 53° of external rotation, and internal rotation to the tenth thoracic vertebra. Improved results were associated with an intact deltoid origin, good-quality rotator cuff tissue, preoperative active elevation of the arm above the horizontal, and only one prior procedure. All seventeen patients who met all four of these criteria had a satisfactory result.ConclusionsThe results of revision rotator cuff repair are inferior to those of primary repair. While pain relief can be reliably achieved in most patients, the functional results are improved principally in patients with an intact deltoid origin, good-quality rotator cuff tissue, preoperative elevation above the horizontal, and only one prior procedure.