Shoulder Repair Tricky Second Time Around

Rotator cuff repair is tricky and the second time around it may not be as durable as the initial repair, according to a study conducted in Australia.

Researchers from the Orthopaedic Research Institute in Sydney conducted a retrospective review of 350 (300 primary, 50 revision) arthroscopic rotator cuff repairs at 6 months and two years postoperatively. They considered standardized patient-ranked outcomes, examiner-determined assessments and ultrasound-determined rotator cuff integrity.

The researchers found that the re-tear rate for the primary rotator cuff repair cohort was 16% at 6 months and 21% at the final two-year follow-up. Patients in the revision cohort showed a 28% re-tear rate at 6 months, a rate that increased to 40% at the final follow-up.

At two years postoperatively, the primary cohort reported less pain at rest, during sleep and with overhead activity compared with the revision group. At the final follow-up, patients who had a primary cuff repair had better forward flexion (+13°), abduction (+18°), internal rotation (+2 vertebral levels), greater strength, lift-off strength and adduction strength when compared to the patients in the revision group.

One of the researchers, Aminudin Mohamed Shamsudin, M.D., commented, “Further studies are needed to identify ways to improve long-term outcomes following revision arthroscopic rotator cuff surgery. However, our results do highlight the long-term success of primary rotator cuff surgery and may help patients understand the realistic expectation of the outcomes of revision arthroscopic rotator cuff surgeries.”