Revision Rotator Cuff Repair
Rotator cuff repair surgery provides good to excellent outcomes whether performed as open surgery or arthroscopic surgery. However, in some cases the repair fails. When a repair fails and the rotator cuff is retorn, revision surgery may be recommended.
What causes a repair failure?
There are several factors involved when a primary repair leads to an unsatisfactory result. These include the size of the original tear, the patient’s biology, and trauma to the shoulder. When the tendon fails to heal after surgery it may be due to extensive damage to the rotator cuff that occurred during the initial injury. The larger the tear, the more complicated the surgery, thus the greater the risk the surgery will fail.
Another reason the original repair failed may be because as we age the structural integrity of the rotator cuff tendons weaken with wear and tear and become prone to tearing with only minimal trauma. Also, a patient can retear or reinjure the rotator cuff. Revision surgery to repair the cuff can be help alleviate symptoms.
What are the symptoms of a failed rotator cuff repair?
It may be difficult to recognize that a cuff repair has failed. Symptoms are often the same as with the original tear including significant pain, loss of strength and stiffness. Sometimes the pain will be in a different location on the shoulder. Yet at times there may be no symptoms, and the patient is able to function well without pain.
Diagnosis
Dr. Johnston will ask you about your previous surgery, what may have caused the symptoms and when symptoms returned. Sometimes the pain persisted after the original surgery; sometimes it improved and then worsened; and sometimes the pain resulted from a new trauma to the shoulder.
He will use special tests to identify the location of the pain and order imaging studies to evaluate the rotator cuff.
Dr. Johnston will request the surgical notes from your first rotator cuff repair which can provide valuable information about the quality of the cuff and the type of repair performed. After reviewing all the evidence, and no improvement after non-operative treatment, he may recommend revision surgery.
The Procedure
Usually, a revision surgery will be done arthroscopically under general anesthesia. The arthroscope will be used to evaluate the condition of the cuff and to repair the damage.
The repair procedure depends on the extent of the tear. Revision arthroscopic surgery is more challenging than the original rotator cuff surgery because there may be multiple component failures. Revision surgery is individualized for each patient's needs.
Revision surgery may include cleaning out the joint by removing damaged tissues, capsular release if needed, and repair of the previously repaired tendon called the subscapularis. Tendon transfer may be used in certain situations.
Dr. Peter Johnston is a board-certified and fellowship- trained shoulder and elbow specialist that manages complex problems of the shoulder with both open and arthroscopic methods and cutting-edge technology in an evidence-based fashion. Contact Dr. Johnston to schedule a consultation today.
