Long-Term Outcome After Structural Failure of Rotator Cuff Repairs

Jost, Bernhard; Zumstein, Matthias A.; Pfirrmann, Christian W. A.; Gerber, Christian

doi:10.2106/jbjs.e.00003

Cited by 201 publications

(173 citation statements)

References 45 publications

(58 reference statements)

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“…Fatty infiltration increased with the severity of the rotator cuff tear (partial thickness tear to massive rotator cuff tear) ( Table 1). Recent reports have focused on defining the influence of fatty infiltration and atrophy on healing and postoperative outcome [10,16,18]. We did not evaluate postoperative integrity of repaired rotator cuffs or clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Natural History of Fatty Infiltration and Atrophy of the Supraspinatus Muscle in Rotator Cuff Tears

Mélis

DeFranco

Chuinard

et al. 2010

Clinical Orthopaedics &Amp; Related Research

204

144

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Background In some patients nonoperative treatment of a rotator cuff tear is sufficient, while in others it is only the first stage of treatment prior to surgery. Fatty infiltration progresses throughout the nonoperative treatment although it is not known at what point fatty infiltration contributes to poor functional outcomes, absence of healing, or increased rerupture rates. Questions/purposes We therefore identified factors related to the appearance of supraspinatus muscle fatty infiltration, determined the speed of appearance and progression of this phenomenon, and correlated fatty infiltration with muscular atrophy. Methods We retrospectively reviewed 1688 patients with rotator cuff tears and recorded the following: number of tendons torn, etiology of the tear, time between onset of shoulder symptoms and diagnosis of rotator cuff tear. Fatty infiltration of the supraspinatus was graded using either CT or MRI classification. Muscular atrophy was measured indirectly using the tangent sign. Results Moderate supraspinatus fatty infiltration appeared an average of 3 years after onset of symptoms and severe fatty infiltration at an average of 5 years after the onset of symptoms. A positive tangent sign appeared at an average of 4.5 years after the onset of symptoms. Conclusions Our results suggest that rotator cuff repair should be performed before the appearance of fatty infiltration (Stage 2) and atrophy (positive tangent sign)-especially when the tear involves multiple tendons.

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Section: Discussionmentioning

confidence: 99%

Natural History of Fatty Infiltration and Atrophy of the Supraspinatus Muscle in Rotator Cuff Tears

Mélis

DeFranco

Chuinard

et al. 2010

Clinical Orthopaedics &Amp; Related Research

204

144

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“…These could also compromise the result from a second procedure if they continue to be present (2,6,9,19) . Among these factors, the following can be cited: 1) Inadequate subacromial decompression, which is one of the main causes of failure after the initial repair (2) .…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that patients who have small or medium-sized lesions at the time of the first procedure tend to evolve with better results from the reoperation than do those who initially presented large or extensive lesions (6,9,19) . In our sample, out of the nine patients with unsatisfactory results, six presented large or extensive lesions in the first procedure, while it was not possible to identify the size of the lesion in two cases, because they were operated at other services (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…Two procedures using an open approach may compromise a greater number of fibers of the deltoid muscle, thus impairing the result; 4) Quality of the suture performed: in cases with loss of function in the presence of an adequate deltoid muscle, this leads towards envisaging that repair failure may have occurred (2) . Factors such as inadequate mobilization of the cuff, freeing of adherences, fatty degeneration of the tendon and inadequate fixation of the tendon to the bone or under tension are possible causes that might compromise the result from the repair, thus leading to recurrence of the lesion (2,6,9,19) . Three of our patients evolved with new tears after the reoperation (Table 1); 5) Inadequate rehabilitation: postoperative rehabilitation may compromise the procedure that has been carried out if it is not done correctly (2) .…”

Section: Discussionmentioning

confidence: 99%

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Avaliação dos resultados das reoperações de pacientes com lesões do manguito rotador

Miyazaki¹,

Fregoneze²,

Santos³

et al. 2011

Rev. bras. ortop.

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“…Their mean age at surgery was 52 years. The minimum followup was 16 years (mean, 20 years; range [16][17][18][19][20][21][22][23][24][25] …”

Section: Methodsmentioning

confidence: 99%

Pain Relief, Motion, and Function after Rotator Cuff Repair or Reconstruction May Not Persist after 16 Years

Borgmästars

Paavola

Remes

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Short-to medium-term rotator cuff repair reportedly relieves pain in 82% to 97% of patients and provides normal or almost normal shoulder function in 82% to 92%. However, it is unknown whether pain relief and function persist long term. Questions/purposes We asked whether, after rotator cuff repair or reconstruction, pain relief, ROM, shoulder strength, and function remained over the long term. Patients and MethodsWe retrospectively reviewed 75 patients who underwent rotator cuff repair between 1980 and 1989. There were 55 men and 20 women. Their mean age at surgery was 52 years. The minimum followup was 16 years (mean, 20 years; range 16-25 years). Results Twenty-eight of the 75 patients (37%) had persistent relief of pain lasting for 20 years. In the remaining 47 patients, alleviation of pain lasted, on average, 14 years (range, 0-24 years). Mean flexion and abduction strength increased postoperatively but during long-term followup decreased to less than preoperative levels. External rotation also decreased. At the last followup, the Constant-Murley score averaged 66 (range, 10-98) in men and 60 (range, 29-89) in women. In the Simple Shoulder Test questionnaire, the mean number of yes answers was eight of 12. Of the 75 patients, 32 (43%) reported impairment in activities of daily living owing to an index shoulder complaint. Severe degenerative changes of the glenohumeral joint were evident in 14 patients (19%). Conclusions The early high functional scores after primary rotator cuff repair or reconstruction of the types we performed in the 1980s did not persist. The function achieved postoperatively was lost, as ROM and strength decreased to less than preoperative values. However, alleviation of pain was long-standing in most patients. Based on our data, we should warn patients to expect less than permanent relief with those repairs. We cannot say whether the same will apply to currently performed types of repairs.

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Long-Term Outcome After Structural Failure of Rotator Cuff Repairs

Cited by 201 publications

References 45 publications

Natural History of Fatty Infiltration and Atrophy of the Supraspinatus Muscle in Rotator Cuff Tears

Natural History of Fatty Infiltration and Atrophy of the Supraspinatus Muscle in Rotator Cuff Tears

Avaliação dos resultados das reoperações de pacientes com lesões do manguito rotador

Pain Relief, Motion, and Function after Rotator Cuff Repair or Reconstruction May Not Persist after 16 Years

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