Recurrent rotator cuff tears: an evaluation of open re-surgery results

The frequency and treatment of recurrent rotator cuff (RC) tears are not clearly defined. Management of symptomatic re-ruptures is a challenge to surgeons. Several options can be chosen, but strict rules do not exist. The objective of this study is to retrospectively evaluate the results of different types of surgery carried out on 36 patients with symptomatic re-rupture of the rotator cuff, over a period of 4 years between 1998 and 2002. Thirty-six patients treated for rotator cuff tears by open surgery were reoperated for pain and weakness, 18 females and 18 males with an average age of 57 (range 40-73 years). Arthro-CT Scan confirmed the recurrence of the tear and evaluated the size, number of tendons involved and the global fatty degeneration index (GFDI) of the muscles. The mean time to reoperation was 30 months (range 3-120). We performed 17 trans-osseous reinsertions, six tendon-tendon sutures, nine repairs using transfer and four reverse prosthesis. Biceps long head tenodesis was performed in 20 cases. No resection of the acromioclavicular (A-C) joint was done. Results were evaluated retrospectively with a mean follow-up of 33 months (range 5-154). Eighteen patients were very satisfied, 14 satisfied and four disappointed. Only, elevation was improved. The Constant score improved from 46 (23-72) pre-operatively to 67 (40-95) post-operatively with a decreasing of the GFDI from 0.8 to 1.60. Upon analysis of the different aspects of the Constant score, it stands out that the best improvement was in relation to pain, which improved from four to 12 points (maximum 15), representing a 200% improvement. The lowest improvement was in strength which improved from six to seven (maximum 25) points, representing a 16% imrovement. Mobility and activity levels improved by 28 and 75%, respectively. Arthro-CT (articular computerized tomography) is the author's preferred method for the diagnosis of recurrent RC tears, and the information obtained may help for the selection of the operative indication. The final result is improved when it is possible to perform a trans-osseous reinsertion for a small recurrent rotator cuff tear with a good trophicity of the muscle. However, for a pseudo paralytic shoulder, a reverse prosthesis can improve the Constant score with restoration of an active forward elevation. Muscle transfer (latissimus dorsi, deltoid or subscapularis transfer) works well for pain relief but provides lower motion improvement.