These authors performed a systematic review of 22 studies to analyze the clinical outcomes of revision rotator cuff repair (RCR) and to identify prognostic factors that may influence postoperative outcomes. Articles were included if they were original studies reporting clinical outcomes of revision RCR via an open or arthroscopic technique.
Revision RCR was performed via an open technique in 44% of cases and via an arthroscopic technique in 56% of cases (n . 452). Revision RCR was performed in conjunction with patch augmentation in 12% of cases.
Open revisions were performed in younger patients than arthroscopic revisions
Compared with arthroscopic revisions, open revisions were less frequently performed in patients with 1 previous operation and more frequently performed in patients with multiple prior surgeries.
Open revisions were more frequently performed in patients with massive or large retears than in patients with medium or small retears.
Patients undergoing arthroscopic revision had greater mean preoperative forward flexion than those undergoing open revision.
Preoperative forward flexion was positively correlated with the postoperative ASES
score and with postoperative forward flexion.
score and with postoperative forward flexion.
The preoperative VAS pain score was positively correlated with the postoperative VAS pain score and negatively with the postoperative ASES score.
The preoperative ASES score was positively correlated with the postoperative ASES score.
Open revision improved forward flexion from 96 to 125 degrees
Arthroscopic revision improved forward flexion from 125 to 146
Open revisions improved ASES scores from 41 to 76.
Open revisions improved ASES scores from 41 to 76.
Arthroscopic revisions improved ASES scores from 47 to 76
The overall complication rate with revision RCR was 12% (97 complications in 809 revisions).
The overall complication rate with revision RCR was 12% (97 complications in 809 revisions).
The complication rates for open and arthroscopic revisions were 8% and 16%, respectively.
The highest complication rate of 17% was noted with open or arthroscopic revision RCR with concomitant graft augmentation.
The most frequent complication was revision RCR failure (88%), followed by persistent shoulder stiffness (5%) and infection (4%).
Complications necessitated reoperations in 7 patients managed by open revision RCR and 30 patients managed by arthroscopic revision RCR. Reoperations included the following: revision RCR in 14, reverse total shoulder arthroplasty in 9, debridement in 5, arthrodesis in 3, subacromialdecompression in 2, capsular release in 1, biceps tenodesis in 1, acromioclavicular joint excision in 1, and pectoralis major transfer in 1.
Comment: The results showed that the better the shoulder's motion, function and comfort were before revision, the better the shoulder after revision. Arthroscopic surgery and graft augmentation had significantly higher rates of complications. No data are presented about cuff integrity after revision RCR.
Comment: The results showed that the better the shoulder's motion, function and comfort were before revision, the better the shoulder after revision. Arthroscopic surgery and graft augmentation had significantly higher rates of complications. No data are presented about cuff integrity after revision RCR.
Patients can experience failure of attempted cuff repair for several distinct reasons. In our experience, stiffness is most common, followed by painful crepitus, weakness and instability. Trying to regain anatomic integrity of the cuff after a prior attempted repair is challenging because at that point the cuff has torn at least twice, rendering it less likely to heal than at the first repair.
However, we know that achieving cuff integrity is not essential to improving the comfort and function of a failed repair. For patients with stiffness or painful crepitus after a failed cuff repair, a simple smooth and move procedure can be effective. The technique for this procedure is shown in this link.
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