Re-tears after rotator cuff repair: Current concepts review

Abstract

Re-tear following rotator cuff repair is common and has been reported to range from between 13 and 94% despite satisfactory clinical outcomes following rotator cuff surgery. Various risk factors have been associated with an increased tear rate, including patient factors, tear and shoulder morphology, repair technique, and rehabilitation regimes. Different modes of rotator cuff failure have been described. The management of re-tear in patients following rotator cuff repair is challenging and depends on the age, functional status and requirements of the patient, and re-tear size and residual tendon length. This article aims to review the factors associated with rotator cuff re-tear. It describes which of these are associated with poor clinical outcomes, and discusses the long-term outcomes of re-tear and treatment options.

Keywords: Failed repair; Re-tear; Revision surgery; Rotator cuff; Shoulder; Superior capsular reconstruction; Tendon transfer.

Fig. 1

Shoulder X-Ray measuring critical shoulder angle (CSA) of 37°.

Fig. 2

MRI Sagittal PD image showing severe atrophy and fatty infiltration of the supraspinatus muscle.

Fig. 3

MRI findings of failed rotator cuff repairs (A) Type 1 failure with no residual tendon attached to tuberosity footprint with major discontinuity, (B) Type 2 failure with tendon stump attached to footprint and medial tendon failure and major discontinuity.