Clinical outcome after structural failure of rotator cuff repairs

Background: The clinical outcome for patients with documented rerupture aft er open repair of one or more rotator cuff tendons is not well known. The p urpose of this study was to evaluate the clinical outcomes of a consecutive series of rotator cuff reruptures after repair and to provide information concerning the advisability of rotator cuff repair in situations in which t here may be a high probability of rerupture, Methods: During prospective follow-up after rotator cuff repairs, we detect ed, with magnetic resonance imaging, structural failure of the repair in tw enty patients, who had a mean age of fifty-nine years at the time of the ro tator cuff repair. All patients were clinically examined for the purpose of this report at a mean of thirty-eight months. Results: The reruptures invariably involved the originally torn tendon but were smaller than the original tear in sixteen of the twenty patients, Fatt y degeneration of the supraspinatus and infraspinatus muscles, atrophy of t he supraspinatus muscle, and glenohumeral osteoarthritis progressed signifi cantly from the preoperative state (p < 0.05), At the time of the most rece nt follow-up, the subjective shoulder value averaged 75 percent of the valu e for a normal shoulder. Eleven patients were very satisfied with the resul t, six were satisfied, two were disappointed, and one was dissatisfied. The mean relative score according to the system of Constant and Murley had inc reased from 49 percent of the score for a normal shoulder preoperatively to 83 percent postoperatively (p = 0.0001). Pain had decreased significantly, and the ranges of active, pain-free forward elevation and abduction as wel l as the abduction strength had improved significantly (p < 0.05), The clin ical outcome was significantly correlated with the size of the postoperativ e tear, the stage of postoperative fatty muscle degeneration of the infrasp inatus and subscapularis, the postoperative acromiohumeral distance, and th e degree of postoperative glenohumeral osteoarthritis (p < 0.05), Conclusions This study documents that an attempt at rotator cuff repair sig nificantly decreases pain (p = 0.0026) and significantly improves function (p = 0.0005) and strength (p = 0.0137) even if magnetic resonance imaging d ocuments that the repair has failed. This finding suggests that the potenti al for rerupture should not be considered a formal contraindication to an a ttempt at repair if optimal functional recovery is the goal of treatment.