I admit as an accountant, I tend to be a bit obsessive-compulsive. So help me keep my perspective here. I'm scheduled to have a rotator cuff tear repaired and I'm looking on-line for information about what to expect. I found several places where it says tendon repairs can fail. How often does this happen? Why does it happen? What can I ask my surgeon to do to keep this from happening to me?
Your questions actually mirror the results of a recent study from the well-known Cleveland Clinic. Perhaps their findings might help you evaluate your own situation and bring about a helpful conversation with your surgeon.
In this study of 14 patients who had a rotator cuff repair, surgeons placed special marker beads in the repaired tendons. Then they used serial low-dose CT scans (repeated at six weeks, 12-weeks, 26-weeks, and one year) to check the position of the anchor beads. Since the beads were inside the tendon, this was a clear representation of the tendon position. Movement of the beads away from the bone signaled tendon retraction (pulling away from the bone).
The surgeons noticed that this retraction did not always mean the tendon would tear. Only about one-third of the group developed an actual recurrent (second) tear in the damaged rotator cuff tendon.
Tendon retraction occurred early after surgery (in the first six to 12 weeks). Those patients who had the most tendon retraction were also the ones who developed a tendon defect. Defect was defined as a full-thickness, fluid-filled gap in the tendon (as seen on CT scan). The authors refer to tendon retraction without defect as a failure with continuity. Retraction and defect did not occur at the same time but rather, retraction developed first that led to the recurrent tendon tear.
Questions that come up from these findings were the same questions you are asking: 1) Why does this happen? 2) How does this affect the patient's function? and 3) What can be done about it? The answer to the first question (why) isn't completely clear.
A couple of clues were uncovered in this study. First, older adults were more likely to experience this tendon retraction/recurrent tear. Tendons that pull through the sutures and repairs that elongate or lengthen in the newly forming tissue during the healing process result in tendon retraction and/or defect.
And second, patients with larger defects to begin with were more likely to develop retraction leading to tendon tear. Both of these factors suggest poor tendon quality at the time of surgery as an important risk factor. These risk factors and findings naturally affect function (question number two) and speculation as to how to prevent it from happening (question number three).
Exactly how to prevent the problem of retraction/recurrence remains unclear. Perhaps reattaching the torn tendon to a different place on the bone might help. There may be other changes in the surgical technique that could help improve the quality of repair. This would have to be studied more closely by comparing results of different suture placement and repair techniques. More study is also needed to understand the mechanisms by which tendon retraction occurs in the first place.
The fact that age is a risk factor suggests that biologic characteristics of the damaged tendon are as important as the type of surgical repair. Small tears can be repaired since function is not affected by tendon retraction but medium-to-large tears should be reconstructed. Patient selection for each type of surgery becomes important as well.
And finally, the clear understanding that the problem develops early on leads to the conclusion that activity in the early days and weeks after surgery must be monitored closely. Too much activity, motion, and force on the healing tissue may contribute to tendon retraction and must be prevented. The fact that 80 per cent of all retractions occurred in the first 12 weeks highlights this as a key time period for protection of the healing tissue in all patients.
Patients should be clearly instructed to follow all of the surgeon's post-operative guidelines carefully and not deviate from the program. Clearly, too much activity, too soon can lead to problems. If, as you describe yourself, there are tendencies toward being obsessive-compulsive, this will aid you in following directions and protecting the healing tissue.
Jesse A. McCarron, MD, et al. Failure with Continuity in Rotator Cuff Repair "Healing." In The Journal of Bone and Joint Surgery. January 2013. Vol. 41. No. 1. Pp. 134-141.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.