Failed Rotator Cuff Surgery
Failed rotator cuff surgery can be a very frustrating and complex issue for both the surgeon and more importantly the patient. Part of the problem in getting a better handle on the issue is that we don’t have a uniformly accepted set of standards to determine success and failure.
For example, the vast majority of patients aren’t aware that a significant number of rotator cuff repairs do NOT heal but the patient may still experience meaningful pain relief and range-of-motion. This article (http://www.medscape.com/viewarticle/758280 ) reinforces the fact that nearly 60% of the tears in this study did not heal. So even though we may subjectively feel that because the patient has good pain relief, it is difficult to objectively call the operation a success when the repair itself failed. A recent article highlights some factors that can help improve the rate of healing of rotator cuff tears (http://amjorthopedics.com/PDF/042040160.pdf ). Again, Dr. Tashjiian notes, “Rotator cuff healing is not necessary for a good long-term functional outcome after rotator cuff repair, although healing will likely result in improved strength and range of motion (ROM).” But when we take a more long term view of the issue and take other factors into account, such as the patient’s ability to return to meaningful strength and activity, gainful employment, time lost from work and productivity, etc. it becomes more clear that a truly successful LONG TERM OUTCOME requires healing of the rotator cuff repair. Dr. Higgins in a recent study highlights this fact, noting that rotator cuff surgeries that don’t result in primary healing of the repair are not cost effective (http://www.healio.com/orthopedics/sports-medicine/news/online/%7Bbdc01bdd-2b3a-4992-b94b-7b0ab17aed24%7D/study-re-revision-arthroscopic-rotator-cuff-repair-may-not-be-cost-effective ).
This may help explain why our primary goal for our patients is always to achieve the highest possible healing rates for all repairs. More information about our methods, results, and protocols are available here: http://www.theshouldercenter.com/failed-rotator-cuff-repair/
Many patients are used to aggressive physical therapy following shoulder surgery and rotator cuff repair and are very surprised to learn that we don’t utilize any aggressive or painful physical therapy because aggressive early motion and stress has been shown to result in failure of primary healing of the rotator cuff. A recent article by Dr. Iannotti and colleagues highlights the fact that the vast majority of rotator cuff repairs fail within the first 6-26 weeks following surgery (http://jbjs.org/data/Journals/JBJS/927015/965.pdf ).
The study concludes, “Retears over the first three months accounted for 42% of the retears that occurred over the time of this study. Half of the retears occurred between twelve and twenty-six weeks after surgery. This finding was not expected and has not been reported in the literature to our knowledge. It demonstrates that rotator cuff healing is prolonged and there is an opportunity to speed healing by protecting the repair from excessive loading. Tissue-engineering strategies should focus on methods to improve the rate of tendon healing or mechanical protection of the repair site. Mechanical augmentation should be sustained for at least six months after surgery. A combination of biological and mechanical enhancement of rotator cuff healing would be of benefit after these repairs.”
As part of our primary focus of improving primary rotator cuff healing, we have been offering graft reinforcement to our patients for challenging rotator cuff repairs for many years and recently reported on the outstanding healing rates utilizing these advanced techniques: http://www.theshouldercenter.com/wp-content/uploads/pdf/Improving-Rotator-Cuff-Healing-Rates-20120602.pdf
So remember, pain relief alone isn’t enough when you are considering moving ahead with shoulder surgery for your rotator cuff tear. Take the time to do your research and find an experienced shoulder surgeon who can provide you with meaningful results. Learn more here: http://www.theshouldercenter.com/video-how-to-choose-a-surgeon-for-your-rotator-cuff-repair/
Get a second, third, or fourth opinion if needed, because this extra time is a lot less painful and expensive than a failed rotator cuff repair. http://www.theshouldercenter.com/medical-second-opinion-on-shoulder-surgery/
You may also be interested in unstable shoulder information.