Clinical problems of structural failure after rotator cuff repairs / 中华骨科杂志

ABSTRACT

Arthroscopic rotator cuff repairs are preformed due to growing knowledge of rotator cuff tears among surgeons as well as patients.However,it is unavoidable and may sometimes very common that some patients develop structural failures or retears after surgical repairs because of unique blood supply and healing procedure of the rotator cuff,on which there is still much debate focusing on problems that one needs to deal with in clinical practice.Retears often occur,if without new trauma,during early postoperative period,or more specifically within the first 6 months after repair and are more frequently observed in those with old ages,diabetes or osteoporosis.In addition,risk factors of retears consist of longer preoperative duration of symptoms,larger primitive tear sizes,higher grades of fatty infiltration of muscles on preoperative imaging examinations,excessive tension within reconstructed structures,deteriorated quality of rotator cuff tissues and special shapes of the acromion,etc.Diagnosis is recently based on results of postoperative magnetic resonance imaging or echogram examination.MR/CT arthrography is also used.Each instrument has its advantages and limitations.However,the lack of a golden standard when establishing a diagnosis of rotator cuff retears makes integrating evaluations and comparisons of different methods a difficult question.It has been reported by many that the onset of retear leads to obvious shoulder pain or weakness,whereas more than a few studies demonstrated that very limited influences of retears in spite of generally unaffected shoulder functions,like decreased muscle strength on certain motions.The disagreement is possibly caused by specific methods of diagnosis,function instruments and time point of assessments used by different researchers as studies have displayed that feelings of patients after surgery and results attained by objective examinations are not always parallel.Moreover,some long-time follow-ups studies indicated that the impact posted by retears on shoulder functions evolves over a period of time.Owing to the varied opinions on actual symptoms and final functional outcomes caused by structural failure,the mainstay of treatment for rotator cuff tears are still conservative protocols,including observation and symptoms relief instead of second surgery.Second surgery could be an effective choice for certain patients,especially for those who have apparent symptoms.