Rotator cuff repair –either open or arthroscopic– can fail for multiple reasons. The failure rates among different surgeons have been reported to range from 11% to 94% with surgeon skill and experience cited as one of the many variables involved. Many other factors including patient related factors such as smoking history, age, size of tear, quality of tissue and compliance (meaning following the restrictions and directions required after surgery to allow healing of the repaired tissue) can also play a part. Our published results for arthroscopic repair of challenging rotator cuff tears are here. We recently also reported on salvage of catastrophic rotator cuff failure.
Because the reasons for a failed rotator cuff repair can be many and complex, we can’t cover them all. What is most important is to start with a thorough evaluation and make sure you have as complete a picture as possible regarding the most important factors responsible in your individual case. After a thorough evaluation, we may recommend additional tests to evaluate the nerve supply to your rotator cuff and the status of the tissues within your shoulder.
The next step is to go over the options for treatment. If the quality of the rotator cuff tissue is good, we may recommend a revision arthroscopic rotator cuff repair.
Even if the initial repair was performed with an open incision, our specialized techniques and experience allow us to repair these tears arthroscopically. We may also discuss additional options with you to help improve the chances of healing based on your unique circumstances.
Another option we may recommend is Arthroscopic Rotator Cuff Repair with Graft Reinforcement. Much like reinforcing the elbow on a jacket or using a patch to repair a bicycle tire, the patch is applied on top of the rotator cuff repair to help share the load and reduce stress on the rotator cuff during the critical healing period. Over time, the patch becomes part of the patient’s own tissue hopefully ultimately resulting in a stronger rotator cuff tendon.
Patch grafts aren’t new and many products to serve this purpose have been available for years. One of the most important questions to consider before using a graft is how will the body react to the graft– or in other words– will the graft be rejected by the body? For instance, the Restore Patch has been available since 1999 and is not recommended due to concerns about complications and rejection. Because of these and other concerns, we avoided using patch grafts until we were comfortable that grafts that would be treated favorably by the patient’s body were available, and we had developed a reliable Arthroscopic Rotator Cuff Repair with Graft Reinforcement Technique. Among the grafts available today, Allopatch HD and GraftJacket appear to have the most favorable supporting science.
Numerous other options –including tendon transfers– may also be considered.
In summary, failed surgeries require careful analysis to prescribe the best possible technique for your individual circumstance.
To schedule an appointment with a shoulder specialist contact us.