Arthroscopic revision of failed rotator cuff repairs: technique and results.

PURPOSE

The purpose of this study was to review the results of arthroscopic revision rotator cuff repair in patients for whom a previous rotator cuff repair had failed.

TYPE OF STUDY

Case series.

METHODS

From October 1998 to October 2000, 14 patients with a mean age of 57.9 +/- 9.2 years underwent arthroscopic revision rotator cuff repair and were available for follow-up evaluation. The mean time from primary to revision procedure was 41.4 months (range, 8 to 240 months). Eleven patients had undergone a previous rotator cuff repair, 2 patients had undergone 2 rotator cuff repairs, and 1 patient had undergone 3 rotator cuff repairs. We found 2 medium, 1 large, and 11 massive recurrent rotator cuff tears, with a mean tear size of 4.4 x 5.5 cm. All large and massive tears required extensive arthroscopic dissection and mobilization of the rotator cuff to delineate the tear margins and repair the rotator cuff. All patients were evaluated preoperatively and postoperatively using a modified University of California Los Angeles (UCLA) scoring system.

RESULTS

At a mean of 23.4 +/- 9.8 months after arthroscopic revision rotator cuff repair, 13 of 14 patients were satisfied with the procedure. The mean UCLA score increased from 13.1 +/- 2.3 preoperatively to 28.6 +/- 7.1 postoperatively (P <.00001). We noted 4 excellent, 5 good, 4 fair, and 1 poor result. The mean active forward elevation increased from 120.7 degrees +/- 48.9 degrees preoperatively to 153.6 degrees +/- 33.1 degrees postoperatively (P =.006). The mean active external rotation increased from 26.1 degrees +/- 19.3 degrees preoperatively to 44.3 degrees +/- 15.9 degrees postoperatively (P =.006). Of the 4 patients without active overhead function preoperatively, 3 gained overhead function postoperatively. One patient who did not regain overhead function had a poor result secondary to anterior deltoid detachment after the primary procedure.

CONCLUSIONS

Revision arthroscopic rotator cuff repair is a technically demanding procedure. However, appropriate patient selection and careful attention to rotator cuff dissection, mobilization, and repair by arthroscopic means can lead to significant improvements in overall shoulder pain and function.

LEVEL OF EVIDENCE

Level 4, case series (no or historical control group).