If you had a rotator cuff repair, but it failed, what's the chance that a 2nd attempt at repair will be successful?

In the March 2010 issue of the Journal of Bone and Joint Surgery (JBJS 2010; 92:590-598), Ken Yamaguchi and his co-authors from Washington University address this very question. They found that re-repair results in reliable pain relief and improvement in function in selected cases. Only half of the revision repairs were intact at 1 year follow-up, and patient age and the number of torn tendons were related to postoperative tendon integrity. Seventy percent of single tendon tears healed; results declined when both the supraspinatus and infraspinatus tendons were torn. They also noted that postoperative abduction strength and functional scores were better when tendon healing actually occurred--which is not surprising. The study was not designed to identify a particular age after which tendon healing is less likely, but it is well known that advanced age is a risk factor for poorer healing---probably more due to the status of the tendon that anything else.

Other factors that may impact on re-repair success include  what your x-ray looks like ( is your humeral head [the ball] centered on the glenoid [socket] or superiorly translated? Is there arthritis?), the health of your rotator cuff muscle (is there fatty infiltration or atrophy on MRI?). A retracted tendon may not be fixable, or there may be too much tension on the repair. When the muscle has atrophied, the functional results following repair decline. And if the ball has migrated superiorly, the kinematics of the shoulder may not be restorable enough to "protect" a repair.


Obviously what one wants to avoid is a revision cuff repair that is not going to work. By the same token, if a revision repair is likely to be successful---that is far better than living with pain or having a salvage procedure like a joint replacement--since the latter will require activity limitation down the road, in comparison. The most appropriate treatment strategy  will depend, in summary,  on a number of factors including  age,  activity expectations,  range of motion and strength, the x-ray,  and the status of your cuff muscle.

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