Revision Rotator Cuff Repair
The rotator cuff consists of muscles and tendons that connect the arm to the shoulder blade. Tears in this network of muscles and tendons are usually repaired by suturing the tendon back to its original position. However, tears can occur even after surgery. In such cases a revision rotator cuff repair may be performed.
Recurrent rotator cuff tears usually occur with large tears. Problems with the initial surgical technique or healing process may also contribute to recurrence. These include the giving way of sutures placed during the original surgical repair due to high tension or improper placement, minor muscle contractions that occur despite postsurgical immobilization, noncompliance with postsurgical instructions, and changes in the properties of the tendon following the injury. Apart from these, advanced age, general health, and the presence of other diseases and medications may also play a role in re-tearing of the rotator cuff.
Persistent pain, loss of function and range of motion several months following surgical repair is usually an indication of a recurrent rotator cuff tear. Sometimes, recurrent tears are asymptomatic and show up during your periodic follow-up visits. During these visits, your doctor will review your history and examine the shoulder for motion, function and strength. It is very important to determine the exact cause of the failed surgical repair. Ultrasound imaging studies may be ordered to evaluate the placement of the sutures and the integrity of the rotator cuff tendons as they heal.
Your doctor will first suggest conservative treatment such as rest, activity modification, using a sling, physical therapy to improve the strength and stability of the joint, and steroid injections to relieve pain and swelling.
If symptoms do not resolve, revision rotator cuff repair will have to be considered. Depending on the type of tear, surgical treatment may include removing frayed tendon ends and re-suturing the tendon if it is healthy. A damaged biceps tendon, which helps in the movement of the elbow, may also be repaired to relieve shoulder pain. An adjacent tendon may be transferred to aid an extensively damaged rotator cuff. If the quality of the bone is not adequate, joint replacement (hemiarthroplasty or reverse shoulder arthroplasty) using metal and plastic prostheses may be considered.
The postoperative phase is critical with revision rotator cuff repairs. A slow and steady rehabilitation program under the guidance of a physical therapist giving the repaired tendons sufficient time to heal will yield a better outcome compared to a more aggressive physical therapy program.