Functional outcomes and structural integrity after double-pulley suture bridge rotator cuff repair using serial ultrasonographic examination JSES

Rotator cuff failure - check out this link

Functional outcomes and structural integrity after double-pulley suture bridge rotator cuff repair using serial ultrasonographic examination JSES

This interesting study of 41 rotator cuff repairs at an average of 28 months showed that 8 (20%) had retorn. The retear rate was greater for larger tears. 2 retears (25%) were identified over a year after surgery. Functional outcomes were not significantly better for the intact group than for the retear group. The observation of tear recurrence after repair is consistent with previous observations (here and here and here and here and here) and with the report in 1991 by Harryman, that a substantial number of repaired cuffs do not remain intact after surgery.

The observation that retear rates seem relatively independent of repair method, suggests that the weak link in rotator cuff repairs is the tendon-suture interface i.e. the failure is due to suture tension overload on the tendon.

The observation that tendon repair integrity does not correlate with clinical outcome (see plot of their data below) suggests that factors other than tendon integrity have a greater influence on the patient's comfort and function.

These authors had their patients wear an abduction brace, which allowed 30 to 45 abduction and slight internal rotation, for 6 weeks. Pendulum exercise and passive shoulder elevation were started the day after surgery for the small- and medium sized tears. For large to massive tears, shoulder motion was restricted for 2 weeks. Brace-free motion and active elevation were allowed at 6 weeks. Strengthening exercise was started from 6 to 8 weeks. Light work and sports activities were started at 3 months, and a return to a routine lifestyle was allowed at 6 months. This begs the question that "if there's no functional difference between intact and retear, why bother to protect the repair for up to 1/2 year?" and even "why bother to attempt to repair the defect in large tears at all?".

Our practice is to discuss with each patient when to repair and when to do a smooth and move.

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