Doubts About Revision Arthroscopic RC Repair

Long-term outcomes of revision arthroscopic rotator cuff (RC) repair surgery are not as successful as in a first-time surgery, according to researchers from the Orthopaedic Research Institute in Sydney, Australia.

“According to our results, patients with revision arthroscopic rotator cuff surgery had gained short-term (six months post operatively) functional and clinical improvements. However, these gains pretty much disappeared by two years following surgery, ” said Orthopaedic Research Institute lead researcher Aminudin Mohamed Shamsudin, M.D., M.Medicine (Ortho) in the March 15, 2014 news release.

Shamsudin and his team analyzed and followed-up with 360 arthroscopic rotator cuff surgery patients where they compared the functional and clinical outcomes of 310 primary cases with that of 50 revision cases. The primary group also had a larger rotator cuff tear on average.

Asked why did you undertake a study of this topic, Dr. Shamsudin told OTW, “I realized that there has been not much information or data or studies that specifically looked into long-term outcomes (a minimum of two years) of revision rotator cuff repairs that were done arthroscopically. As more of these cases are becoming fashionable treatment option for the surgeon, the consensus on the outcomes are merely speculative based on the many published outcomes of primary arthroscopic cuff repairs. So, there had been a gap of information in the particular area.”

Asked what was surprising to him, he noted, “The outcomes took a different path a two-year post-surgery. The functional outcomes of the revision cases were inferior and their re-tear rate was double at two years when compared with the primary cases. The functional outcomes and re-tear rates of both groups were somewhat similar only up to six-months post-surgery. These similarities did not sustain at two years after surgery.”

Asked what needs to be done differently with these surgeries, “Well, we are comparing outcomes of repair from a freshly torn rotator cuff against that of a previously repaired cuff that had most likely undergone a degree of attempted/failed healing with resultant fibrosis and lacking ability for neo-vascularization. Perhaps we should take a back seat and look for very clear indication for a need of revision cuff repair and not subject a high proportion of re-tear cases to another surgical repair while expecting the same good outcome from a primary repair. We should also focus on conservative rehabilitation on the re-torn cases. Perhaps a study to compare these will help show the role conservative treatment can have on re-torn cases.”

He added, “I think orthopaedic surgeons should make it clear to the patients not to expect outcomes as good as that in a primary repair case. Let the patients play a bigger role in deciding for a revision surgery.”