Question:I had one of the new mini-open rotator cuff repairs three months ago. At first it was very, very stiff. Then I increased my exercises and re-injured the repaired tendon. Would it have been better to have the open incision operation after all?
Answer:Hindsight is always 20-20 -- meaning it's easier to look back and see what might have been better than to look ahead and predict what's best. In many cases there's simply no way to tell what's best for each patient.
Surgery to repair a rotator cuff tear has changed from a full, open-incision operation to all-arthroscopy with no incision. The mini-open repair is in between those two options with a small incision made during arthroscopic surgery.
Failure rates with recurrence of the rotator cuff tear are fairly equal between the mini-open repair and the all-arthroscopic procedure. Other factors may be at work here. Tendon quality, abnormal scarring, and postoperative rehab program may influence recurrence rates. Larger tears are more likely to tear again.
Postoperative stiffness is a common problem after the mini-open operation. Extra stretch is put on the deltoid shoulder muscle when the surgeon works through a small incision. There have also been reports of repair failure from a rehab program that's too aggressive. For example, using weights with an overhead pulley too soon after surgery has been linked with a high rate of repair failure. Overloading the repair site can result in re-injury.Nikhil N. Verma, MD, et al. All-Arthroscopic Versus Mini-Open Rotator Cuff Repair: A Retrospective Review with Minimum 2-Year Follow-up. In The Journal of Arthroscopic and Related Surgery. June 2006. Vol. 22. No. 6. Pp. 587-594.
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