The reoperation of failed rotator cuff repairs.

BACKGROUND: Operative management of a failed primary rotator cuff repair is very difficult, and the results are also less satisfactory. In order to identify which factors are responsible for the failure of the initial surgery and which factors are correctable with reoperation, the results of surgical treatment for failed initial rotator cuff repair were analyzed. METHODS: Twenty patients with a previous repair of the rotator cuff received a second operation for pain and functional impairment. The second repair was performed with an average interval of 11.8 months from the primary repair. The average follow-up was 60.7 months and the results were rated on the basis of pain, range of motion and function. RESULTS: Multiple factors accounted for the failure of initial surgery: large to massive tear at the time of previous repair (80%), persistent subacromial impingement (75%), poor condition of the deltoid muscle (35%), rupture of the long head of biceps tendon (25%), poor quality of cuff tissue (25%) and severe subacromial or intra-articular adhesion (20%). After reoperation, 15 patients (75%) had pain free or occasional aching soreness. Eleven patients (55%) had active forward elevation over 120 degrees, while the average preoperative motion was 80 degrees and the postoperative motion was 127 degrees. Twelve patients (60%) had no functional impairment or were left with some restriction. Over-all satisfactory results were noted in eleven patients (55%). CONCLUSIONS: The most common factors associated with the failure of the initial repair were large to massive tear and inadequate acromioplasty. Most factors could be avoided at the initial repair, while several factors such as irreparable massive tear, poor deltoid function and poor cuff tissue were very difficult to be corrected at the repeat repair. The primary goal should be relief of pain instead of functional improvement. Since the results were not consistent, careful assessment and management should be made in the initial attempt.