Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I just came back from the orthopedic surgeon's office. I don't know if I should be upset or not. Twelve weeks ago, I had a rotator cuff repair. I opted for a repair instead of the full-blown reconstruction. But the CT scan showed the tendon is pulling away from where the surgeon stitched it to the bone. The surgeon didn't seem that concerned. I'm totally freaked.

Answer:

Studies are beginning to show that early on after rotator cuff tendon repair, the tendon retracts or pulls away from the bone. A recent study from the well-known Cleveland Clinic reported all rotator cuff repairs pulled away from where they were sutured (stitched in place). It was a fairly small study but repeated findings from other studies. Special marker beads were placed in the repaired tendons of 14 patients. The surgeons used serial (repeated at six weeks, 12-weeks, 26-weeks, and one year) low-dose CT scans 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. 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. So your surgeon may not be concerned because the original tear was small, the amount of retraction now is minimal, the tendon repair looks good, or all three. Patients who have significant tendon retraction are also the ones most likely to develop a tendon defect. Defect is defined as a full-thickness, fluid-filled gap in the tendon (as seen on CT scan). Surgeons refer to tendon retraction without defect as a failure with continuity. Retraction and defect do not seem to occur at the same time but rather, retraction develops first and that leads to recurrent tendon tear for some patients. Older patients with larger defects to begin with are 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. Your surgeon may also be taking into consideration your age as another reason not to be too concerned (that is, if you are younger). They found that patients who developed a tendon retraction that led to a tendon defect did lose shoulder/arm function but not strength of the scapular (shoulder blade) muscles. Tendon retraction alone (remember: failure with continuity) did not result in loss of function. So once again, taking all these variables into consideration, your surgeon may not see you at risk for further change in the final repair. But now that you have returned home and have questions, concerns, or doubts, don't hesitate to call your surgeon for a follow-up conversation to find out more about why he or she is not overly concerned. 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.
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