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The Journal of Bone and Joint Surgery, Vol 74, Issue 10 1505-1515, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Operative treatment of failed repairs of the rotator cuff
LU Bigliani, FA Cordasco, SJ McIlveen and ES Musso
Shoulder Service, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York City 10032.
Thirty-one patients had a repeat repair after a failure of a previously
performed repair of the rotator cuff, and the causes of the original
failure and the results of the repeat repair were analyzed. The clinical
situation was complex, with multiple factors contributing to the failures.
A large or massive tear of the cuff in thirty patients (97 per cent) and
persistent subacromial impingement in twenty-eight patients (90 per cent)
were the most common factors associated with failure. The over-all result
of the repeat repair was satisfactory in sixteen patients (52 per cent) and
unsatisfactory in fifteen (48 per cent). Twenty-five patients (81 per cent)
had satisfactory relief of pain. However, fourteen patients (45 per cent)
had persistent weakness that led to an unsatisfactory result. The factors
that were associated with a better result were an intact acromion, an
intact origin of the deltoid muscle, and the finding that the remaining
tissue of the rotator cuff was of good quality. The factors that were
associated with an inferior result were a previous lateral acromionectomy,
a previously detached origin of the deltoid muscle, and the finding that
the tissue of the rotator cuff that was available at the time of the repeat
operation was of poor quality. Persistent pain is the primary indication
for a repeat repair. The functional results are not as predictable,
especially when the tissue of the cuff is poor and the deltoid origin has
been detached previously.
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