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Current concepts review: revision rotator cuff repair
The healing rates of primary rotator cuff repair (RCR) are variable. 5,24,33 As RCR becomes more commonly performed, more failures will require surgical revision. Revision RCR is a more complicated process than primary RCR due to poor tissue quality, retained hardware, patient factors and expectations, and the sequelae of postoperative complications. Successful revision RCR requires a complete understanding of the anatomy of the rotator cuff, diagnosis of failed RCR, causes of failure, indications for operative intervention, and unique technical factors of surgical revision.
Causes of failed RCR
Causes of failed RCR can be categorized as surgical complications, diagnostic errors, technical errors, failure to heal, and traumatic failure (Table I). Failed RCR is often multifactorial, and these factors have significant overlap. Determining the causes of failure and correcting these
factors, when possible, are important to achieve successful revision RCR.
The overall complication rate of arthroscopic RCR is approximately 10%.7 Complications associated with open and arthroscopic RCR include disruption of the deltoid origin, infection, foreign body reaction, stiffness, and neurologic injury. These complications lead to a poor result after RCR and may also contribute to failure of the repaired rotator cuff tissue.
Failure of the deltoid after RCR may occur gradually or acutely. Deltoid disruption can occur in open repair as a result of rupture of the repaired deltoid muscle and fascia. Excessive deltoid release from the lateral acromion can also result in deltoid failure in mini-open RCR. In addition, overly aggressive anterior acromioplasty with inappropriate anterior deltoid release in arthroscopic RCR may lead to deltoid disruption and even acromial fracture. Patients with deltoid failure may present with a defect in the deltoid or significant weakness with forward elevation or abduction, or both.