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Current concepts review: revision rotator cuff repair
Michael S. George, MDa,*, Michael Khazzam, MDb
Failed rotator cuff repair may be caused by surgical complications, diagnostic errors, technical errors, failure to heal, and traumatic failure. Revision rotator cuff repair is made technically more difficult by poor tissue quality, tissue adhesions, and retained suture and suture anchor material.
Historically, open revision rotator cuff repair yields inferior results compared with primary rotator cuff repair; however, more recent studies show 52% to 69% satisfactory results in small-sized or medium-sized tears. Arthroscopic revision rotator cuff repair yields greater than 60% good or excellent results. Poor tissue quality, detachment of the deltoid origin, and multiple previous surgeries are risk factors for poor results in 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 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.