Management of failed rotator cuff repair: a systematic review

Abstract

Importance: Recurrent tear after rotator cuff repair (RCR) is common. Conservative, and open and arthroscopic revisions, have been advocated to treat these failures.

Aim or objective: The purpose of this systematic review was to evaluate the different options for managing recurrent rotator cuff tears.

Evidence review: A search was conducted of level I through 4 studies from January 2000 to October 2015, to identify studies reporting on failed RCR. 10 articles were identified. The overall quality of evidence was very low.

Findings: Mid-term to long-term follow-up of patients treated conservatively revealed acceptable results; a persistent defect is a well-tolerated condition that only occasionally requires subsequent surgery. Conservative treatment might be indicated in most patients, particularly in case of posterosuperior involvement and poor preoperative range of motion. Revision surgery might be indicated in a young patient with a repairable lesion, a 3 tendon tear, and in those with involvement of the subscapularis.

Conclusions and relevance: The current review indicates that arthroscopic revision RCR can lead to improvement in functional outcome despite a high retear rate. Further studies are needed to develop specific rehabilitation in the case of primary rotator cuff failure, to better understand the place of each treatment option, and, in case of repair, to optimise tendon healing.

Figure 1

Six patterns of anatomic deficiency associated with failed rotator cuff repair. (A) Failure of tendon healing; (B) poor tendon quality; (C) fatty infiltration/atrophy; (D) retear medial to the medial row of fixation; (E) bone defects in the greater tuberosity after anchor removal, or perianchor cyst formation and (F) bony and tendinous insufficiency.