Saturday, December 13, 2014

What factors favor healing of a rotator cuff repair?

Factors affecting rotator cuff healing.

These authors conducted a current concepts review of factors affecting healing of full thickness cuff repairs.

They point out that the integrity of the rotator cuff after repair surgery can only be ascertained if reliable advanced imaging shows a continuous layer of tissue from the muscle to the insertion on the tuberosity. Comment: This may not actually be the case. See this post for a discussion of failure in continuity.

Outcome measures that include measurements of strength or active motion (such as the Constant and UCLA scores) show higher scores when the tendon remains intact, whereas those scores based on patient-reported outcomes tend not to show a difference in outcome between intact and failed repairs - i.e. the patient perceived function is not affected by tendon healing.

In the authors' assessment of the literature the following factors did not affect the healing rate:
*open vs. arthroscopic repairs, 
*single vs. double row repairs, 
*medial vs. lateral knot placement, 
*suture anchor type, 
*type of tuberosity preparation, 
*structural augmentation,
*platelet rich plasma or fibrin matrix
*early vs. late motion

Healing rate was influenced by
*patient age
*tear size
*bone mineral density
*fatty infiltration
*amount of tendon retraction

Comment: What is interesting about the two lists above, is that the first (those factors unassociated with healing rate) are those under the control of the surgeon while the second (those factors associated with healing rate) are not under the surgeon's control. When we discuss with a patient the likelihood of a successful surgical repair we review the 'encouraging' and 'discouraging' factors as shown here.  If the chances of a durable repair seem slim, we explain that we favor a smooth and move procedure, avoiding the protracted down time necessary to protect a surgical repair. The smooth and move has also proved to be effective in the management of failed cuff repairs.


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