Results after Revision Arthroscopic Rotator Cuff Repair: A Prospective Multi-Center Analysis

Abstract

Primary arthroscopic rotator cuff repair has shown to provide reliable clinical results with a low re-tear rate. Rotator cuff re-tears following surgical repair are associated with poor shoulder function and unsatisfactory clinical results. Data regarding the role of revision arthroscopic rotator cuff repair (RARCR) are sparse. Hence, this study aimed to investigate the clinical and radiological results following RARCR. It was hypothesized that (1) RARCR would lead to an improved clinical outcome and that (2) the clinical results would be dependent on tendon integrity at two years. During a 3-year period, 100 patients who underwent RARCR were prospectively enrolled in this multi-center study of ten European shoulder centers. Clinical results were evaluated pre-operatively, at six months and at two years by the Constant Score (CS), the Oxford Shoulder Score (OSS) and the Subjective Shoulder Value (SSV). Tendon integrity was analyzed by MRI at two years using the Sugaya classification. 13 patients (13%) were lost to follow-up. All clinical scores improved significantly during the study period (CS from 44±16 preoperatively to 58±22 at six months to 69±19 points at two years; OSS from 27±8 preoperatively to 36±11 at six months to 40±9 points at two years; SSV from 43±18% preoperatively to 66±24% at six months to 75±22% at two years; p < .01). At two years, a re-tear rate of 51.7% and a surgical revision rate of 12.6% were observed. While the Sugaya score improved from 4.5±0.9 preoperatively to 3.7±1.4 at two years, tendon integrity could not be correlated with better outcome scores. Prior open rotator cuff repair, involvement of the subscapularis tendon and medial cuff failure were correlated with poorer SSV scores at two years (p < .05). While RARCR leads to an improved clinical outcome, re-tears are frequently observed at a mid-term follow-up. Patients with re-tears, however, do not necessarily have poorer shoulder function than those with healed tendons. Patient satisfaction was lower when the primary surgery was performed by an open technique, when an associated lesion of the subscapularis was present and when the rotator cuff re-tear was located at the musculotendinous junction.