Editorial Commentary: Rotator Cuff Tear: Know When Not to Operate So You Don't Make It Worse

Abstract

Shoulder rotator cuff repair results in significantly improved outcomes compared with conservative treatment, but some repairs result in retear and, worst of all, enlarged retears (i.e., tears larger after surgery than primarily). Elevated serum total cholesterol and low-density lipoprotein levels and fatty infiltration of the infraspinatus are significantly related to symptomatic failed rotator cuff repair. Hypertension could also be a risk factor. In such cases, nonoperative treatment, reverse shoulder prosthesis (in older patients), or alternative joint-preserving procedures (superior capsular reconstruction, subacromial balloon spacer, multiple-tendon interposition autografts, augmentation of the long head of the biceps, or tendon transfers such as latissimus dorsi transfer and lower trapezius transfer) could be considered or are worthy of future investigation.

Outcomes of Isolated Biceps Tenodesis/Tenotomy or Partial Rotator Cuff Repair Associated with Biceps Tenodesis/Tenotomy for Massive Irreparable Tears: A Systematic Review

“…Authors demonstrated significant worst outcome when retears, a partial repair improves functional outcomes but may make the patient worse [ 29 ]. Fatty infiltration was found to be a risk factor for enlarged retear [ 52 ]; other factors were increased levels of total cholesterol and low-density lipoprotein [ 52 , 53 ]. Although we did not compare the postoperative protocol, we can assume that PCR-BT is more demanding, with longer immobilization and rehabilitation, and more immediate postoperative pain than BT.…”