|Beitragstitel||Outcome of Revision Rotator Cuff Repair|
Structurally failed rotator cuff repair is not necessarily associated with a poor clinical outcome, but sometimes may require further surgical treatment. Often, revision rotator cuff repair is performed, with however very little data available in the literature to help in the decision making process. The goal of the here presented work was to analyze our results in this set of patients.
Isolated revision rotator cuff repair was performed at our institution from Jan 2008 to Dec 2012 in 51 subjects (mean 53 years), of these, 31 were available for clinical and radiological (ultrasound) follow up (mean 32 months), including Constant score (CS), subjective shoulder value (SSV), and pain (VAS).
Of the 31 patients, there were 9 recurrent failures, including 7 supraspinatus, 4 subscapularis and 1 infraspinatus repairs, and in 7 patients a trauma was recorded. In the intact versus failed shoulders, the age adjusted constant score improved from 55 to 76 points and 55 to 65 points respectively, global flexion from 131° to 147° and 122° to 130° respectively, SSV from 48 to 69 points and 40 to 46 points, respectively, VAS from 5.2 to 2.2 and 5.9 to 4.8 points, respectively. Force improved from 2.1 to 3.7kg and 2.0 to 2.6kg. For the intact versus failed cuffs, for the pre- versus postoperative fatty infiltrations (if available) were SSP: 1.8 to 1.4 and 2.3 to 3.8, ISP: 2.0 to 1.5 and 1.8 to 2.3. SSC: 1.3. to 1.0 (failed n.a.).
Revision rotator repair has the potential to improve patient satisfaction from SSV 48 to 69 points, with objective improvements in function and pain. However, if the revision fails, the results appear far inferior to a failure in a primary repair (SSV 40 to 46 points), particularly regarding pain, with almost no improvement there. This represents the largest study analyzing the outcome of revision cuff repair with a relatively low recurrence rate compared to previous reports. If conditions are favorable, mostly represented by good muscle quality, revision rotator cuff repair may be a useful treatment option with a final outcome not necessarily far inferior to primary repair.