Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I don't really have a question, just a comment. My mother had a rotator cuff repair against the best advice of her surgeon. She was warned that there is a high rate of failure. Her age (87), her diabetes, and her smoking were said to be big obstacles against her. But her main surgeon said it was her brittle bones that were the final straw. Please tell your patients to listen to the advice their doctors give them. It could save families a boatload of money and suffering.

Answer:

We couldn't have expressed it any better but here is a bit of additional information that might help everyone facing rotator cuff surgery. Most of the time, rotator cuff surgery is successful with excellent results. Patients experience pain relief, increased shoulder motion, and improved function. But there can be some problems. In particular, as your mother was told, the rate of rotator cuff repair failure can be pretty high. Multiple studies have shown that the failure rate after rotator cuff repair ranges from 20 to 94 per cent. There are reasons for the high failure rate. It doesn't just happen randomly. For example, we know that medical problems such as diabetes, high blood pressure, osteoporosis, and heart disease are risk factors for poor tendon healing. And recently, a study from Seoul National University College of Medicine in Korea added some valuable information. After examining the medical records of 272 patients who had a rotator cuff repair, there were three significant prognostic factors for failed healing: 1) low bone mineral density (BMD), 2) fatty infiltration, and 3) tendon retraction. Low bone mineral density (BMD) is the hallmark finding in osteoporosis (brittle bones). Without good, solid bone structure, the suture anchors used in the repair loosen and pull out before tendon healing occurs. Suture anchors are used to reattach the torn tendon to the bone. Statistical analysis showed that patients with low bone mineral density had 7.25 times more chance of failed rotator cuff tear surgery compared with patients who had normal bone. The second prognostic factor (fatty infiltration) was found to be an independent risk factor for failed rotator cuff repairs. Patients with higher amounts of fatty infiltration were more likely to have unhealed responses. Of the four tendons that make up the rotator cuff, fatty infiltration of the infraspinatus tendon was the most significant prognostic factor. The third and final factor was tendon retraction. The further the tendon pulls away from the bone, the greater the risk of tendon repair failure. There isn't anything the patient can do to change fatty infiltration or tendon retraction. The surgeon can use specific surgical techniques to work with the soft tissues for the best results. The real benefit of this study was in recognizing the role of osteoporosis in rotator cuff tear healing. By measuring bone mineral density before surgery, patients at increased risk for failed tendon healing can be identified. With careful management of low bone mineral density it may be possible to improve the healing rate of surgically repaired rotator cuff tears. This is an important "take home" message for all of our readers. If you are an older adult and thinking about having rotator cuff surgery, rotator cuff repair may not be as successful as it is with younger patients. The best source of advice is your surgeon. Ultimately, the final decision is the patient's though and sometimes they do know what is best for themselves. Weighing the risk against the benefit is easier when there is additional information available about risk factors, predictive factors, and prognostic factors. Seok Won Chung, MD, et al. Factors Affecting Rotator Cuff Healing After Arthroscopic Repair. In The American Journal of Arthroscopic Repair. October 2011. Vol. 39. No. 10. Pp. 2099-2107.

*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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