The Journal of Bone and Joint Surgery (American) 83:1849-1855 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Revision Rotator Cuff Repair: Factors Influencing Results
Mladen Djurasovic, MD,
Guido Marra, MD,
Julian S. Arroyo, MD,
Roger G. Pollock, MD,
Evan L. Flatow, MD and
Louis U. Bigliani, MD
Investigation performed at the Department of Orthopaedic
Surgery, New York Presbyterian Hospital—Columbia Presbyterian
Medical Center, New York, NY
Mladen Djurasovic, MD
Roger G. Pollock, MD
Louis U. Bigliani, MD
Department of Orthopaedic Surgery, New York Presbyterian Hospital—Columbia
Presbyterian Medical Center, 622 West 168th Street, PH-11th Floor,
New York, NY 10032
Guido Marra, MD
Department of Orthopaedic Surgery, Loyola Medical Center, 2160
South 1st Avenue, Maywood, IL 60153
Julian S. Arroyo, MD
Lakewood Orthopaedic Surgeons, 5605 100th Street S.W., Tacoma,
WA 98499
Evan L. Flatow, MD
Department of Orthopaedic Surgery, Mount Sinai Medical Center,
5 East 98th Street, New York, NY 10029
The authors did not receive grants or outside funding in support
of their research or preparation of this manuscript. They did not
receive payments or other benefits or a commitment or agreement
to provide such benefits from a commercial entity. No commercial
entity paid or directed, or agreed to pay or direct, any benefits
to any research fund, foundation, educational institution, or other
charitable or nonprofit organization with which the authors are
affiliated or associated.
A commentary is available with the electronic versions of this
article, on our web site (www.jbjs.org) and on our quarterly CD-ROM
(call our subscription department, at 781-449-9780, to order the
CD-ROM).
A video supplement to this article is available from the Video
Journal of Orthopaedics. A video clip is available at the
JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can
be contacted at (805) 962-3410, web site: www.vjortho.com.
Background: Revision rotator cuff repair is
a surgical challenge, and the results have generally been inferior
to those of primary repair. We examined the results of revision
rotator cuff repair in a large series of patients and assessed which
subgroups of patients had the greatest chance for a satisfactory
functional outcome.
Methods: A revision rotator cuff repair was performed
in eighty patients after the failure of a previous operative repair. The
average age of the patients at the time of the revision was fifty-nine
years. Prior to revision, the average pain score was 7.4 points
(with 0 points indicating no pain and 10 points, severe pain) and
the active range of motion of the shoulder averaged 105° of elevation,
39° of external rotation, and internal rotation to the eleventh thoracic
vertebra. All patients underwent repeat repair of the rotator cuff
tendons to bone. Additional procedures included revision acromioplasty
(fifty-three patients; 66%) and distal clavicular excision
(twenty-six patients; 33%), among others.
Results: After an average duration of follow-up
of forty-nine months, the result was rated as satisfactory (excellent, good,
or fair) in fifty-five patients (69%) and as unsatisfactory
(poor) in twenty-five (31%). At the time of the latest
follow-up, the average pain score had improved to 3.0 points and
the active range of motion averaged 130° of elevation, 53° of external
rotation, and internal rotation to the tenth thoracic vertebra.
Improved results were associated with an intact deltoid origin,
good-quality rotator cuff tissue, preoperative active elevation of
the arm above the horizontal, and only one prior procedure. All
seventeen patients who met all four of these criteria had a satisfactory
result.
Conclusions: The results of revision rotator cuff
repair are inferior to those of primary repair. While pain relief
can be reliably achieved in most patients, the functional results
are improved principally in patients with an intact deltoid origin,
good-quality rotator cuff tissue, preoperative elevation above the
horizontal, and only one prior procedure.
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