Monday, January 29, 2018

Complications Following Arthroscopic Rotator Cuff Repair and Reconstruction

Complications Following Arthroscopic Rotator Cuff Repair and Reconstruction

These authors start their review with these statements, "Rotator cuff tears are common in the general population. Many patients with rotator cuff tears remain asymptomatic, but others have pain and functional disability warranting surgical intervention. It has been estimated that 250,000 to 275,000 rotator cuff repairs are performed in the United States annually."

They review a range of complications after cuff surgery, including infection, anchor displacement, stiffness, chondrolysis and nerve injury.

However, the most frequent complication they listed was retearing or failure of healing, which they noted in 4.5% to 94% of repair attempts. The predominant site of failure is noted to be at the tendon-suture interface, indicating that the quality of the edge of the torn tendon is a limiting factor in the durability of the repair.  They state, "the true clinical effect of a retear is unknown".   Patient-reported outcomes did not differ significantly between patients with a healed rotator cuff and those with a structural failure. 

Comment: These observations brings up two questions:

(1) "What makes some cuff tears symptomatic, while most remain asymptomatic"?
(2) "If the clinical outcomes of repair surgery are similar whether or not the repair is intact, what determines the quality of the result after rotator cuff surgery?"