Clinical Outcomes of Single-row Arthroscopic Revision Rotator Cuff Repair

Abstract

This article reports the authors' experience with single-row arthroscopic revision rotator cuff repairs and analyzes the variables associated with a poorer long-term outcome. A retrospective review was performed of patients who had undergone an all-arthroscopic, single-row revision rotator cuff repair for pain with a documented re-tear over a 13-year period. After exclusionary criterion was applied, 32 shoulders in 30 patients were available for follow-up. A thorough shoulder examination was performed to record postoperative motion and functional outcomes, including the University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) pain score, and was compared with the patient's preoperative data. Analysis of variables, including patient demographics, surgical history, and functional outcomes, was performed to determine whether there was any association with a UCLA score less than 28 or an ASES score less than 65. At final follow-up, 20 men and 10 women had a mean age of 69.3 years (range, 55.1-84.1) at a mean follow-up of 70.3 months after final revision surgery. Mean UCLA score improved from 15.5 ± 3.9 preoperatively to 29.8 ± 4.6 postoperatively (P<.001); mean modified ASES score improved from 53.4 ± 12.5 preoperatively to 86.7 ± 12.7 postoperatively (P<.001); and mean VAS pain score improved from 4.6 ± 1.1 preoperatively to .91 ± 1.1 postoperatively (P<.001). A poorer functional outcome (defined as a UCLA score greater than 28) was found in 25% of patients. This was associated with female gender, age older than 70 years, dominant-arm revision, and preoperative external rotation less than 35°. In addition, preoperative active range of motion in forward flexion less than 140° (P=.039) and active range of motion in external rotation less than 35° (P=.025) were also associated with poorer ASES scores (<65). The authors believe that patients can have reliable improvements in shoulder pain and function after a revision procedure using a single-row arthroscopic technique and that patient factors can lead to poorer results with this technique.

Management of failed rotator cuff repair: a systematic review

“…Female sex 15 28 34 and, in one study, if the surgery was performed on the dominant arm, were negatively associated with postoperative outcome. 15 There is still controversy about certain risk factors such as age of patients. 15 24 28 …”

“…Disease-related factors included patients with a recurrent tear after the revision repair, 24 preoperative VAS pain score greater than five 28 and poor preoperative range of motion. 15 18 22 28 34 63 The ranges vary from less than 90° in the studies from Piasecki et al 34 and Denard et al 63 to 140° in the study of Chuang et al . 15 The latter factor has been reported in almost all series and is probably the most important preoperative indicator.…”

“… 15 18 22 28 34 63 The ranges vary from less than 90° in the studies from Piasecki et al 34 and Denard et al 63 to 140° in the study of Chuang et al . 15 The latter factor has been reported in almost all series and is probably the most important preoperative indicator. In addition, acromiohumeral distance (<7 mm) can be associated with a satisfactory outcome.…”

“… 28 30 34 In all studies except one, 40 the sling was discontinued after 6 weeks. Strengthening was delayed until 6, 38 12 15 18 22 30 33 34 40 to 16 weeks 24 28 postoperatively. Full return to activity was not allowed until 4, 24 6, 38 or even 12 months.…”

Expectations Following Rotator Cuff Surgery

“…Several However, there is a discrepancy in the literature between anatomic healing and functional results-with many patients still able to achieve a clinically successful result despite evidence of radiographic failure of the repair [16,17].…”