Rotator Cuff Repair–Again

Surgeons carefully study the results of their handiwork. When surgery doesn’t have a good result, they want to know why. Then they can make whatever changes are necessary. In the case of rotator cuff repair, pain relief and good motion occur in up to 90 percent of cases. Other past studies are not so optimistic, suggesting that unsatisfactory results occur in up to 25 percent of cases.

When contemplating rotator cuff surgery, the doctor must decide which surgical technique to use. This decision is made by looking at the size of the muscle tear, the size and shape of the bones, and the health of the tissue. The best result occurs when the tendon can be repaired directly. In this case, the tendon is replaced using its original attachments with a secure tendon-to-bone repair.

When a repaired rotator cuff has a poor or unsatisfactory result, the surgeon may have to perform a procedure called a revision. Revision surgery is usually the second or third surgery after the initial injury and repair. In a revision, a direct repair is not possible. The tendon may have to be reattached in a new location slightly forward or to the side of its usual place. Sometimes a piece of tendon from another place in the shoulder has to be used to replace the original tendon. There are many different ways to perform a revision.

Revision surgery on the rotator cuff is most successful when four conditions are met: (1) the deltoid muscle is not torn; (2) the rotator cuff tissue is in good condition; (3) the patient has good motion before the revision; and (4) there has only been one prior surgery. Evaluating each patient for these four conditions can help assure a more successful revision and greater patient satisfaction.