Revision Rotator Cuff Surgery
Revision rotator cuff surgery is a procedure undertaken when an initial rotator cuff repair fails or does not yield the expected outcomes. The goal of revision surgery is to improve shoulder function and alleviate pain, although the outcomes may not be as favorable as with the initial surgery.
Failure to heal is not an uncommon occurrence. It may be caused by factors such as technical errors, surgical complications, biological issues, patient noncompliance and traumatic failure. The complexity of this surgery and the factors leading to its necessity are multifaceted, encompassing both biological and mechanical aspects. The board-certified shoulder experts at Silicon Valley Orthopedics will address these complicating factors to increase the chance of successful revision surgery.
- Biological issues: The biology of the patient plays a crucial role in the healing process. Poor tissue quality, inadequate blood supply, and age-related degeneration can impede healing. Young and active patients with good tissue quality and no muscle atrophy have a much higher repair success rate when compared to elderly patient with poorer tissue quality. Additionally, systemic factors like diabetes or smoking can negatively affect tissue repair and healing.
- Mechanical factors: Improper surgical technique or failure of the surgical repair, such as suture breakage or anchor pullout, or retained hardware are mechanical reasons for failure. Overuse or trauma post-surgery can also disrupt the repair.
- The complexity of the tear: Larger and more complex tears have a higher failure rate. These tears are more challenging to repair and have a higher tendency to re-tear.
- Muscle atrophy and fatty infiltration: Chronic rotator cuff tears can lead to muscle atrophy and fatty infiltration, reducing the muscle’s ability to function and heal properly.
- Other complications: Other complications such as stiffness or scar tissue formation can also contribute to suboptimal outcomes.
Revision surgery is considered in a variety of scenarios:
- Persistent Pain and Dysfunction: If pain, weakness, or limited range of motion persists despite adequate post-operative rehabilitation, it may indicate a failure of the initial repair.
- Re-tear of the Rotator Cuff: Identified through imaging studies like MRI or ultrasound, a re-tear of the repaired tendon is a direct indication for revision surgery.
- Inadequate Improvement: If the patient’s shoulder function does not improve as expected, it may warrant a re-evaluation and possibly a revision surgery.
- New Injury or Trauma: If the shoulder experiences new trauma or injury post-surgery, it can lead to the failure of the initial repair.
Before opting for revision surgery, a thorough evaluation is essential. This will include taking a detailed medical history, a physical exam to understand the patient’s symptoms and limitations, and evaluation of previous surgical interventions. MRI or ultrasound can assess the status of the rotator cuff repair, muscle quality, and any other shoulder pathology. It’s also important to align the surgical goals with patient expectations.
The surgical technique used for revision rotator cuff surgery depends on the unique features of the tear and the surgeon’s preference. Revision surgery is more challenging than the initial repair due to factors such as scar tissue, changes in anatomy, and poorer tissue quality.
Tissue grafts may be necessary when the tendon tissue is poor. Often, other shoulder pathologies like biceps tendonitis or shoulder impingement are addressed during the revision surgery. Further, several surgical aides such as bone marrow stimulation (microfracture) and bioinductive implants can help the healing process by inducing the growth of new tendon tissue.
Revision rotator cuff repairs may be performed minimally invasively. Arthroscopic revision repair offers many advantages over open repair including smaller incisions, less tissue trauma and faster healing. It allows the surgeon to evaluate the joint more thoroughly and if additional problems are discovered, those can be addressed before repairing the rotator cuff.
The rehabilitation following revision surgery is often more prolonged and cautious:
- Immobilization: The shoulder may need to be kept immobilized for a longer period to allow for healing.
- Physical Therapy: A tailored, and gradual physical therapy program is crucial to regain range of motion, strength, and function.
- Patient Compliance: Adherence to rehabilitation protocols and avoiding activities that may jeopardize the repair is vital.
The outcomes of revision rotator cuff surgery are generally less favorable compared to primary repairs. However, the skilled and experienced shoulder surgeons at Silicon Valley Orthopedics, significant improvements in pain, function, and quality of life can be achieved.
Schedule a shoulder consultation
When you or a loved one has shoulder pain or injury, contact Silicon Valley Orthopedics to schedule a consultation. We have offices in Fremont, Los Gatos and Menlo Park. At Silicon Valley Orthopedics we strive for compassionate, personalized care and treatment options geared to your needs.