Medial Rotator Cuff Failure After Arthroscopic Double-Row Rotator Cuff Repair

Persistent tendon defects after rotator cuff repair are not uncommon. Recently, the senior author has identified a subset of 5 patients (mean age, 52 years; range, 42 to 59 years) after arthroscopic double-row rotator cuff repair who showed an unusual mechanism of tendon failure. In these patients the tendon footprint appears well fixed to the greater tuberosity with normal thickness. However, medial to the intact footprint, the tendon is torn with full-thickness defects through the rotator cuff. All patients were involved in Workers' Compensation claims. Magnetic resonance arthrography showed an intact cuff footprint but dye leakage in all patients. Revision surgery was performed at a mean of 8.6 months after the index procedure and showed an intact rotator cuff footprint but cuff failure medial to the footprint. Four patients had repair of the defects by tendon-to-tendon side-to-side sutures, whereas one did not undergo repair. Medial-row failure of the rotator cuff is a previously unreported mechanism of failure after double-row rotator cuff repair. Given the small number of patients in this study, it is unclear whether these defects are symptomatic. However, repair of these defects resulted in improvement in pain in 4 of 5 patients.     

Editorial Commentary: Postoperative Pain Management After Arthroscopic Rotator Cuff Repair: The Journey to Pain Relief

Presently, interscalene block is the undisputed gold-standard procedure for postoperative pain management after arthroscopic rotator cuff surgery in patients experiencing considerable pain. However, the challenge is to make this short-term total pain relief long-term.     

Medial-Row Failure After Arthroscopic Double-Row Rotator Cuff Repair

We report 4 cases of medial-row failure after double-row arthroscopic rotator cuff repair (ARCR) without arthroscopic subacromial decompression (ASAD), in which there was pullout of mattress sutures of the medial row and knots were caught between the cuff and the greater tuberosity. Between October 2006 and January 2008, 49 patients underwent double-row ARCR. During this period, ASAD was not performed with ARCR. Revision arthroscopy was performed in 8 patients because of ongoing symptoms after the index operation. In 4 of 8 patients the medial rotator cuff failed; the tendon appeared to be avulsed at the medial row, and there were exposed knots on the bony surface of the rotator cuff footprint. It appeared that the knots were caught between the cuff and the greater tuberosity. Three retear cuffs were revised with the arthroscopic transtendon technique, and one was revised with a single-row technique after completing the tear. ASAD was performed in all patients. Three of the four patients showed improvement of symptoms and returned to their preinjury occupation. Impingement of pullout knots may be a source of pain after double-row rotator cuff repair.     

Trends Associated with Open Versus Arthroscopic Rotator Cuff Repair

HSS Journal ® - Rotator cuff (RTC) repair is performed using open/mini-open or arthroscopic procedures, and the use of arthroscopic techniques is increasing. The extent to which surgery has...     

The Factors Affecting Pain Pattern after Arthroscopic Rotator Cuff Repair

Background

We evaluated the factors that affect pain pattern after arthroscopic rotator cuff repair.

Methods

From June 2009 to October 2010, 210 patients underwent arthroscopic rotator cuff repair operations. Of them, 84 patients were enrolled as subjects of the present study. The evaluation of postoperative pain was conducted by visual analog scale (VAS) scores during postoperative outpatient interviews at 6 weeks, 3 months, 6 months, and 12 months. The factors that were thought to affect postoperative pain were evaluated by dividing into three categories: preoperative, operative, and postoperative.

Results

Pain after arthroscopic rotator cuff repair surgery showed a strictly decreasing pain pattern. In single analysis and multiple regression tests for factors influencing the strictly decreasing pain pattern, initial VAS and pain onset were shown to be statistically significant factors (p = 0.012, 0.012, 0.044 and 0.028, respectively). With regard to the factors influencing lower than average intensity pain pattern for each period, the stiffness of internal rotation at 3 months postoperatively was shown to be a statistically significant factor in single and multiple regression tests (p = 0.017 and p = 0.004, respectively).

Conclusions

High initial VAS scores and the acute onset of pain affected the strictly decreasing postoperative pain pattern. Additionally, stiffness of internal rotation at postoperative 3 months affected the higher than average intensity pain pattern for each period after arthroscopic rotator cuff repair.     

Effect of Acromioplasty on Postoperative Pain Following Rotator Cuff Repair

Background: The surgical treatment of rotator cuff tears traditionally involves rotator cuff repair (RCR) with concomitant acromioplasty. However, there is some doubt as to whether acromioplasty is of value to this procedure. Questions/Purpose: We sought to evaluate whether RCR with acromioplasty provided better outcomes than RCR without acromioplasty in a cohort of more than 1000 patients. Methods: This retrospective cohort study involved 1320 patients with rotator cuff tears who subsequently received a primary arthroscopic RCR, with acromioplasty (n = 160) or without acromioplasty (n = 1160), performed by a single surgeon. Acromioplasty was performed if there was significant mechanical impingement on the rotator cuff. To assess outcomes, all patients completed a standardized, modified L’Insalata questionnaire in which they reported the level and severity of pain at rest and during activities. An examiner assessed shoulder strength and range of motion before and 1 week, 6 weeks, 12 weeks, and 6 months after surgery. Results: Patients who had RCR with concurrent acromioplasty had a greater level of pain and more frequent pain 1 week after surgery. However, at 6 months there were no differences between patients who underwent RCR with or without acromioplasty in any patient-reported outcome (level of pain with overhead activity, at rest and during sleep; frequency of pain with activity, sleep and extreme pain, difficulty of activity overhead and behind back, level of shoulder stiffness; and overall shoulder satisfaction). The postoperative re-tear rate in both groups was 13%. Conclusion: This study showed no additional benefit to acromioplasty in patients undergoing RCR.