Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

With all the reports on rotator cuff repairs I've read about on-line, I'm getting the idea that the surgery isn't all that successful. And I'm in the process of trying to decide for myself whether or not to have this operation. What would you advise?

Answer:

Most people who have a rotator cuff repair are very pleased with the results. When you read reports on-line of "high" failure rates, you are most likely getting the surgeon's view. Anything short of a perfect surgical result can be classified as a "failure." So-called failure rates do range from low (13 per cent) up to 94 per cent. But the truth is the overall rate is most likely more like one-fourth to one-third. And in those cases reported as "failed" procedures, there are patients who remain asymptomatic -- in other words, without symptoms (no pain, no stiffness, no loss of motion). From the patient's perspective, the surgery was a success. Meanwhile, surgeons around the world continue to examine their patients for any clues as to the reason for any failures and how to combat this problem. For example, in a recent study, Austrian surgeons offered their expertise in answering the question of why there is such a high failure rate after rotator cuff surgery. In an analysis of 95 patients over an 11 year period of time, they found an overall failure rate of 33 per cent. Most of those weren't really retears but rather a failure to heal. Their observations as reported in this article are very similar to what other surgeons are finding in other locations. The patients were followed closely with physician examinations and ultrasound images taken every three months for the first year. Pain, range-of-motion, strength, and function were also evaluated. They used the American Shoulder and Elbow Surgeons (ASES) and Constant scores to assess these results. They also took a look at recreational and sports activity levels. Continued follow-up was done in the same way every year. In this way, the surgeons were able to see at what point a prognosis or prediction could be made about the final results. One MRI was done about five years after the surgery. The surgeons could see that patients with the larger tears were more likely to be in the rerupture group. And as expected, there was a direct relationship between retears and scores on the functional tests. The question was then raised: with continued high rates of retears, should rotator cuff repairs be done? The authors conclude Yes because the majority (two-thirds) of their patients had a successful repair. They got significant pain relief and return of motion, strength, and function. For those patients who had a failed result, this study supports the idea that it's because the repair didn't heal. And those reruptures don't heal on their own. Small tears have a chance of self-healing but most retears tend to get larger over time. For patients who have a successful healing in the first six months, the long-term results are excellent. Patients with large tears (more than two centimeters in size) can expect persistent pain and loss of motion, strength, and function. Thus, the authors conclude the timing (early) and size of tear do predict final clinical outcomes. The task remains to find ways to perform the surgery so that everyone has an excellent result and retears are eliminated (or at least decreased considerably). Rainer Kluger, MD,et al. Long-Term Survivorship of Rotator Cuff Repairs Using Ultrasound and Magnetic Resonance Imaging Analysis. In The American Journal of Sports Medicine. October 2011. Vol. 39. No. 10. Pp. 2071-2081.

*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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