Failed arthroscopic rotator cuff repairs - the importance of patient selection.

It is estimated that at least 25% of individuals over 60 years of age and almost 50% of individuals over the age of 70 have problems with rotator cuff function and integrity. Hundreds of thousands of rotator cuff surgeries are performed each year at costs estimated at over $7 billion. The reported percentage of rotator cuff repairs that fail after arthroscopic rotator cuff repair (ARCR) because of postoperative re-tear ranges from 10 to 94%. 

For these reasons it is important to understand which patients are likely to have a failed repair. A recent article attempted to address this question.

Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review

These authors assessed 14 studies from 6 countries with a total of 5693 patients. 

Their meta-analysis revealed that the risk factors for re-tear after rotator cuff repair were age, body mass index, diabetes, subscapularis and infraspinatus fatty infiltration, symptom duration, bone mineral density, tear length, tear width, tear size area, amount of retraction, critical shoulder angle, acromiohumeral interval, distance from the musculotendinous junction to the glenoid, operative duration, biceps procedure, and postoperative University of California Los Angeles shoulder score.

Comment: While the authors suggest that this study may lead to "targeted prevention and treatment strategies for modifiable risk factors, which are of great significance for reducing the occurrence of rotator cuff retear after ARCR", it is not clear that any of the identified risk factors are actually modifiable. The value of this analysis may lie primarily in its guidance in the selection of patients for ARCR who do not have the risk factors and, thus, are more likely to have a successful repair.

A discussion of the evaluation and management of patients with cuff tears can be found in the Rotator Cuff Tear Book (see this link).

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link)

Shoulder arthritis - x-ray appearance (see this link)

The smooth and move for irreparable cuff tears (see this link)

The total shoulder arthroplasty (see this link).

The ream and run technique is shown in this link.

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

Shoulder rehabilitation exercises (see this link).

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Note that author has no financial relationships with any orthopaedic companies.