Question:I had arthroscopic surgery to repair a torn rotator cuff in my right shoulder. Two months later, it tore again. I wasn't expecting that to happen at all. Was there any way to predict that was going to happen?
Answer:Retears of the torn rotator cuff vary from patient to patient. It can be difficult to predict who might be at risk. Patients with severe or massive tears are certainly at increased risk. Small tears are less likely to retear. Conversely, large tears are at increased risk for rerupture.
Only about five per cent of the patients with small tears retear at a later time. That's compared to 40 per cent for patients with massive, complete tears. As you might expect, the condition of the tendon at the time of the surgery makes a difference.
Size of the tear and tissue quality must be considered. A tendon with frayed and retracted ends can be a problem. The surgeon may not be able to sew the ends together or attach the tendon to the bone where it belongs. Shoulders with poor tendon quality and severe muscle degeneration are more likely to need traditional open surgery. Arthroscopic repair may not be adequate.
Some surgeons are using a double-row of sutures now to help stabilize the repair site. Studies have shown greater fixation strength using this method. The contact area is improved with double- versus single-row sutures.
So you see, there are many factors to consider. And we haven't even mentioned patient compliance with the rehab process. Patients who don't follow the surgeon or the therapist's directions are also at increased risk for rerupture.
The surgeon may be able to identify the risk factors at play in your case. You may want to ask him or her this question at your next follow-up appointment.Hiroyuki Sugaya, MD, et al. Repair Integrity and Functional Outcome After Arthroscopic Double-Row Rotator Cuff Repair. In Journal of Bone and Joint Surgery. May 2007. Vol. 89-A. No. 5. Pp. 953-960.
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