Clinical and biomechanical performance of patients with failed rotator cuff repair

Abstract

PurposeThe purpose of the study was clinical and advanced biomechanical evaluation of shoulder function with respect to rotator cuff (RC) integrity following repair.MethodsThis was a retrospective study of 111 cases with solid single row rotator cuff repair and a minimal one-year follow-up. The RC repair was performed as an open procedure in 42 patients, arthroscopically assisted in 34 and fully arthroscopic in 48 cases. Evaluation protocol included ultrasound evaluation of the RC integrity, clinical evaluation using shoulder scores and advanced biomechanical evaluation (isometric and the isokinetic strength testing).ResultsUltrasound evaluation revealed complete retear in 16 %, partial retear in 10 % and intact repair in 74 % of the cases.Isometric testing of flexion and abduction had shown that shoulders with complete retear were weaker by 45 % compared to those with full tendon healing.Isokinetic testing revealed 29–43 % deficits in peak external rotation torque comparing complete retear vs. normal healing. Patients’ ability to generate shoulder power and withstand a load proved to be lower in circumstances of a complete lack of healing (40–43 % and 34–55 %, respectively). Partial retears did not have a negative impact on the biomechanical properties of shoulders. Surprisingly, there were no significant differences in the shoulder scores related to the quality of healing. In terms of patient satisfaction the results were good and the patients declared themselves better in all cases, no matter what quality of healing had been recorded ultimately.ConclusionsAccording to the results of this research rotator cuff integrity after open or arthroscopic repair does not seem to affect clinical scores. Recurrent tears may result in lower muscle performance in terms of active motion, strength and endurance. Advanced shoulder testing may be essential in assessing the patients’ ability to return to sports or heavy labour.

2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears

“…3 Of note, subjects with failed cuff repairs have outcome scores that are not significantly different from subjects whose repairs have healed, 6,14,16,17,28 except when the outcome is heavily based on strength assessment (eg, the Constant score), in which case healed repairs have better outcomes. 4,5,7,20,21 The physical therapy program in this study was highly effective in alleviating patient symptoms despite the fact that patients continued to have tears of the rotator cuff. This leads one to believe that pain may not be the best indication for rotator cuff repair.…”

Rotator cuff repair with a tendon–fibrocartilage–bone composite bridging patch

“…Such constant tensile loading may cause repair gap formation, which prolongs tendon-to-bone healing 12; 18 and is a precursor of possible future repair failures 19; 20 . Thus, not only does the tendon-to-bone interface not regenerate after repair, but the mechanical strength of the replacement scar tissue is lower than the native interface 4; 21 . Although various methods, including growth factor regulation, use of biological agents, cell therapy, gene therapy, and tissue engineering approaches have been applied to improve tendon-to-bone healing, mechanical properties of the repaired tendon are still inferior to those of normal tissues because of the impaired healing between dissimilar tissues 22–24 .…”

“…However, up to 17% to 94% of patients are reported to have partial or full-thickness retears when evaluated postoperatively by ultrasound or magnetic resonance imaging 1–3 . Postoperative retears, especially large ones, greatly affect range of motion, decrease muscle strength, and cause pain 4; 5 . Various mechanical and biological approaches have been developed to prevent retears, including improved suture techniques, bone substitutes, periosteum autografts, growth factors, gene therapy, stem cell transplantation, and others 6–9 .…”

Capstan screw rotator cuff repair: a novel two-row mini-open technique

“…Thus, this provides even more incentive to achieve as solid a repair as possible. 21,22 The present study reports a clinical re-tear rate of 3.4%, an imaged re-tear rate of 6.8%, a satisfaction rate of 91%, an improvement in OSS of 22.7 points (p < 0.0001) and an improvement in flexion of 51 (p < 0.0001). Such a strong repair has allowed us now to move to a rapid rehabilitation regime with patients returning to work and function much earlier than previously.…”