n Feature Article
Clinical Outcomes of Single-row
Arthroscopic Revision Rotator Cuff Repair
Michael J. Chuang, MD; Jason Jancosko, DO, MPT; Wesley M. Nottage, MD
abstract
Full article available online at Healio.com/Orthopedics
This article reports the authors’ experience with single-row arthroscopic revision rotator cuff
repairs and analyzes the variables associated with a poorer long-term outcome. A retrospective review was performed of patients who had undergone an all-arthroscopic, single-row
revision rotator cuff repair for pain with a documented re-tear over a 13-year period. After
exclusionary criterion was applied, 32 shoulders in 30 patients were available for follow-up.
A thorough shoulder examination was performed to record postoperative motion and functional outcomes, including the University of California Los Angeles (UCLA) score, American
Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) pain score, and
was compared with the patient’s preoperative data. Analysis of variables, including patient
demographics, surgical history, and functional outcomes, was performed to determine
whether there was any association with a UCLA score less than 28 or an ASES score less than
65. At final follow-up, 20 men and 10 women had a mean age of 69.3 years (range, 55.184.1) at a mean follow-up of 70.3 months after final revision surgery. Mean UCLA score improved from 15.5±3.9 preoperatively to 29.8±4.6 postoperatively (P<.001); mean modified
ASES score improved from 53.4±12.5 preoperatively to 86.7±12.7 postoperatively (P<.001);
and mean VAS pain score improved from 4.6±1.1 preoperatively to .91±1.1 postoperatively
(P<.001). A poorer functional outcome (defined as a UCLA score greater than 28) was
found in 25% of patients. This was associated with female gender, age older than 70 years,
dominant-arm revision, and preoperative external rotation less than 35°. In addition, preoperative active range of motion in forward flexion less than 140° (P=.039) and active range
of motion in external rotation less than 35° (P=.025) were also associated with poorer ASES
scores (<65). The authors believe that patients can have reliable improvements in shoulder
pain and function after a revision procedure using a single-row arthroscopic technique and
that patient factors can lead to poorer results with this technique.
The authors are from The Sports Clinic Orthopedic Medical Associates, Inc, Laguna Hills, California.
Drs Chuang and Jancosko have no relevant financial relationships to disclose. Dr Nottage receives
fellowship support from ConMed/Linvatec, Smith & Nephew, and Arthrex.
Correspondence should be addressed to: Michael J. Chuang, MD, The Sports Clinic Orthopedic Medical Associates, Inc, 23961, Calle de la Magdalena #229, Laguna Hills, CA 92653 (michael
[email protected]).
Received: December 11, 2013; Accepted: January 30, 2014; Posted: August 11, 2014.
doi: 10.3928/01477447-20140728-54
e692
ORTHOPEDICS | Healio.com/Orthopedics
n Feature Article
P
ainful recurrent tears of the rotator
cuff are not uncommon after arthroscopic or open primary surgical repair. Tendon re-tear and an impaired
healing response after surgical repair are
likely multifactorial but often include
biologic factors (ie, patient age, tear size,
tendon quality), quality of surgical repair,
trauma, and inappropriate postoperative
rehabilitation.1-5 Reported re-tear rates
vary in the literature but have ranged anywhere from 7% to 69% depending on the
initial tear size and primary method of
repair.6 Although many patients continue
to achieve good pain relief and function
despite rotator cuff re-tear after primary
repair,7-10 some evidence indicates that
those that maintain structural integrity of
the repaired tendons may do better with
more strength than those that re-tear or
never heal.11 Those that have unacceptable return of function and strength may
require revision rotator cuff repair, commonly due to persistent pain.
Several outcome studies in the literature have found high levels of longterm patient satisfaction after primary
arthroscopic rotator cuff repair.12-14 The
existing literature on long-term outcomes
for revision arthroscopic rotator cuff repair is less abundant. A systematic review
by Ladermann et al15 identified only 4
articles (2 articles contained the same patient population) in the current literature
that discussed the outcomes of revision arthroscopic rotator cuff repair incorporating data using various repair techniques.
It is controversial whether a double-row
repair is clinically superior to a singlerow repair in primary rotator cuff repairs.
Little literature exists to explore this concept in revision cases. The purpose of the
authors’ current study was to report on
the functional outcomes after single-row
arthroscopic revision rotator cuff repair.
The authors hypothesize that with the
evolution of techniques in arthroscopic
rotator cuff surgery, a good result can be
obtained in the revision setting with just a
single-row repair. The secondary purpose
AUGUST 2014 | Volume 37 • Number 8
was to evaluate any factors that may relate
to a poorer surgical outcome as defined
by a University of California Los Angeles (UCLA) score16 less than 28 or an
American Shoulder and Elbow Surgeons
(ASES) score less than 65.17,18
Materials and Methods
A retrospective database review of all
patients who had undergone arthroscopic rotator cuff repair from April 1999 to
April 2012 at the authors’ institution by a
single surgeon (W.M.N.) was conducted
and revealed 1230 cases in 843 patients.
Of these, 58 cases were determined to be
all-arthroscopic revision rotator cuff repairs. The surgeon used only a single-row
repair technique in his revision rotator cuff
cases, which was verified in the operative
reports of the 58 cases. Institutional review board approval was obtained prior to
the review of the surgical cases and contact of the patients for participation in the
study. All patients underwent an informed
consent process prior to enrollment and
subsequent inclusion in the study.
Inclusion criteria were patients who
had failed conservative treatment of previous open or arthroscopic rotator cuff
repair with documented re-tear seen on
magnetic resonance imaging and a persistently painful shoulder. A minimum
follow-up of 1 year after revision arthroscopic single-row repair was also
required for inclusion. Both partial and
complete repairs at the time of revision
surgery were included. Exclusion criteria
included any revision repair that was converted to an open procedure, irreparable
rotator cuff defects in which no repair
was attempted, or revision repair that was
completed with biologic tissue grafting.
The medical records of all patients were
reviewed to obtain baseline demographic
data (age, gender, hand-dominance, side
of surgery), number of previous revision
rotator cuff repairs, detailed clinical/surgical history and examination findings,
and available preoperative visual analog
scale (VAS) pain scores, UCLA scores,
and modified ASES scores. The standard
ASES patient self-reported evaluation
consists of a pain scale component and 10
functional activities of daily living component questions (both equally weighted
50 points each) for a total score of 100
points. Omitting the last question item on
the standard ASES evaluation form (ability to “do usual sport”) allowed for calculation of the “modified ASES” score by
weighing the total score calculated from a
total of 95 points instead of 100. The authors chose to perform a modified ASES
score because the initially standard ASES
functional outcome scores were not being used for preoperative data collection
by the senior author (W.M.N.); however,
a similar patient self-reported functional
outcome scoring system that used all of
the same components of the current ASES
score except for the last question item was
being used. Thus, the authors used the
modified ASES score to allow for direct
comparison between pre- and postoperative function.
All patients deemed eligible for the
study were contacted and evaluated by the
sports medicine fellow (J.J.). Functional
outcomes were determined with patientcompleted validated clinical outcome
scoring systems, including UCLA scores,
modified ASES scores, and VAS pain
scores. Patients also underwent a clinical
examination by the fellow, independent of
the surgeon, to determine active range of
motion (AROM) in forward flexion and
external rotation with the arm at the side.
All AROM measures were performed 3
times and averaged to the nearest whole
number. Medical records and operative
reports were analyzed by the sports medicine fellow, who was not involved in any
of the revision surgical procedures.
All arthroscopic revision rotator cuff
repairs were performed by the senior author. With the patient in the lateral decubitus position and the arm in balanced suspension (7 lb), a diagnostic arthroscopy
of the shoulder is performed. The rotator
cuff is inspected from the subacromial
e693
n Feature Article
space laterally after subacromial bursectomy, and a determination of tear size
is performed prior to any cuff debridement. Tear size is classified as small (<1
cm), medium (1-3 cm), large (3-5 cm), or
massive (>5 cm), based on the work of
DeOrio and Cofield.19 The tear pattern,20
mobility, and reducibility to the footprint
are then determined. Biceps tenotomy
and incorporation into the repair or release were performed in all cases with
significant (over 50%) biceps tendon involvement or any subluxation. Subacromial decompression was not routinely
performed in the revision cases, leaving
the coracoacromial ligament and arch intact at a minimum. Subscapularis tendon
tears were repaired when encountered.
The surgeon performed a thorough capsular and coracohumeral ligament release in
all cases.
Although interval slides can be helpful
to gain additional mobility, in this case series anterior interval slide was used in less
than 5%, and only in cases where the goal
was to translate the rotator cuff laterally 1
to 1.5 cm to reach the greater tuberosity.
Double and posterior interval slides were
not performed due to the risk of vascular
compromise to the cuff. Margin convergence using a side-to-side technique was
routinely performed to “shrink” the tear
and bring it to the greater tuberosity.21
Once the tear was converged near the
greater tuberosity, a single-row repair was
performed with anchors next to the articular margin. The authors do not routinely
perform transosseous equivalent repairs
or lateral row supplementation. Although
the goal of the repair was to establish a
complete anatomic tension-free repair, depending on the degree of tissue loss and
tension, the surgeon will perform a partial repair to reestablish the force couples
if complete repair over-tensions the construct.22,23
Postoperatively, patients are routinely
placed in a sling immobilizer with an abduction pillow for the first 6 weeks postoperatively and are started on pendulum
e694
and gentle passive range of motion exercises immediately. Active range of motion is allowed at 6 weeks postoperatively,
with progression to strengthening starting
at 3 months postoperatively. Return to full
activity is generally allowed at 1 year.
Statistical calculations were performed
with Excel 2007 software (Microsoft,
Redmond, Washington). Continuous data
were described by mean, standard deviation, and ranges. Paired t tests were
performed to compare preoperative and
postoperative measurement variable
data including AROM, VAS pain scores,
UCLA scores, and modified ASES scores.
Fisher exact test was used to conduct univariate analysis of nominal variables, such
as patient factors (eg, age, gender, arm
dominance, tobacco use, workers’ compensation status, postoperative AROM)
or surgical factors (eg, number of previous revisions, time of last repair to final
revision, complete vs partial repair) that
may be prognostic of poorer outcomes
(UCLA score <28 and ASES <65). A cutoff UCLA score of <28 was chosen based
on the categories described by Ellman et
al.16 of excellent (34-35 points), good (2833 points), fair (21-27 points), and poor
(0-20 points). An ASES score of <65 was
chosen based on the work of Tashjian et
al.,18 where a 12- to 17-point change in the
ASES score was found to be the minimally
clinically important change. Because the
authors’ average preoperative ASES score
and modified ASES score were 50.7 and
53.4, respectively, the addition of 15 or 12
points to each (both in the described range
of 12 to 17) gives a minimally acceptable
score of 65. P values less than .05 were
considered to be statistically significant.
Results
Office database review revealed 58
surgical cases of single-row arthroscopic
revision rotator cuff repairs in 56 patients
who met the study inclusion criteria. All
eligible patients were contacted for study
recruitment. Of the 56 patients available
for review, 26 patients refused to partici-
pate or could not be reached for this study.
This left 32 surgical cases of 30 patients
who participated in examination for this
study.
Demographic data of the 30 patients
(Table 1) revealed a mean age of 69.3±7.9
years (range, 55-84 years) with a mean
follow-up of 70.3±45 months (range, 13165 months). Twenty (66.7%) men and 10
(33.3%) women, with 20 (62.5%) right
shoulder and 12 (37.5%) left shoulder
surgeries, participated. The dominant arm
was involved in 27 (90%) cases. Mean
age at time of last revision arthroscopic
rotator cuff repair was 63.9±8.5 years
(range, 45.7-77.6 years), with a mean
time from primary repair to last revision
of 62.9±61.6 months.
A mean of 1.2±.45 prior rotator cuff
repair procedures were reported in the
ipsilateral shoulder prior to the final arthroscopic revision rotator cuff repair;
with 28 (87.5%) patients having 1 previously attempted rotator cuff repair, 3
(9.4%) having 2 previously attempted
repairs, and 1 (3.1%) having 3 previous attempted repairs before the final
arthroscopic revision rotator cuff repair. The previous procedures also included subacromial decompression in 18
(56.3%) cases, distal clavicle excision in
5 (15.6%), biceps tenotomy or tenodesis
in 1 (3.1%), superior labral tear anteriorposterior repair in 1 (3.1%), and concomitant anterior stabilization in 1 (3.1%). Of
the 37 prior attempted repairs, 19 (51.4%)
were through an open approach and 18
(48.6%) were attempted arthroscopically.
At the time of final revision surgery,
19 massive (59.4%), 6 large (18.8%),
and 7 medium (21.8%) rotator cuff tears
were reported.19 Complete repairs with
single-row fixation were performed in 26
(81.2%) patients, whereas only partial repairs were obtained in 6 (18.8%) patients.
One anterior interval slide (3.6%) was
performed; no posterior or double interval
slides were performed. Margin convergence sutures were used in 18 (56.3%)
cases. All repairs in this cohort were per-
ORTHOPEDICS | Healio.com/Orthopedics
n Feature Article
Table 1
Demographic Characteristics of the Cohort (N=32)
Demographic
Value
Mean±SD age at final follow-up, y
69.3±7.9
Gender, No. (%)
Male
20 (66.7)
Female
10 (33.3)
Dominant arm, No. (%)
19 (59.4)
Tobacco, No. (%)
4 (13.3)
Diabetes mellitus, No. (%)
0 (0)
Rheumatoid arthritis, No. (%)
1 (3.1)
Workers’ compensation, No. (%)
4 (12.5)
Mean±SD age at last revision (y)
63.9±8.5
Mean±SD time from primary repair to last revision, mo
62.9±61.6
Mean±SD No. of previous surgeries
1.2±.45
Type of previous repair, No. (%)
Arthroscopic
18 (48.6)
Open
19 (51.4)
Tear size, No. (%)
Massive
19 (59.4)
Large
6 (18.8)
Medium
7 (21.8)
Revision repair type, No. (%)
from a mean of 4.6±1.1 preoperatively
to a mean of 0.9±1.1 postoperatively
(P<.001). The mean active forward flexion trended from 146.4°±37.3° preoperatively to 155.7°±16.5° postoperatively
but did not reach statistical significance
(P=.140). The authors did not find a significant difference in external rotation motion (P=.211).
To the authors’ knowledge, no patients
required repeat surgery or revision rotator
cuff repair. Univariate analysis of prognostic factors associated with poor results
is shown in Table 3. A poor or fair functional result, defined as a UCLA score less
than 28, was found in 8 (25%) of 32 procedures. These cases were associated with
age at last revision surgery greater than 70
years (P=.012), female gender (P=.005),
the dominant arm being the surgical side
(P=.038), and preoperative AROM external rotation less than 35°. A poorer clinical results, defined as a ASES score less
than 65, was associated with a preoperative AROM of forward flexion less than
140° (P=.039) and an AROM of external
rotation less than 35° (P=.025).
Complete
26 (81.2)
Partial
6 (18.8)
Discussion
Margin convergence
18 (56.3)
Although primary arthroscopic rotator
cuff repair has shown predictably good outcomes at both short- and long-term followup,12-13,24-28 the initial outcomes reported
after revision repair were mainly on open
surgery and revealed minimal functional
gains despite overall significant pain relief.19,29-31 The existing literature evaluating
outcomes after revision arthroscopic rotator cuff repair is limited. The recent systematic review by Ladermann et al.15 identified only 4 studies and found significant
improvements in postoperative motion and
functional scores. The review found poorer
results associated with female patients, retears after the revision repair, preoperative
active forward flexion less than 135°, and a
VAS pain score greater than 5. Some disagreement has occurred as to whether patient age or the number of prior surgeries
is prognostic.15
Mean±SD No. of anchors used
1.8±.63
Associated procedures performed, No. (%)
Modified subacromial decompression
17 (53.1)
Biceps tenotomy or tenodesis
8 (25)
Stabilization
2 (6.3)
formed with single-row technique using
a mean of 1.8±.63 anchors (range, 1-4).
Additional procedures at the time of final
revision surgery included a modified acromioplasty in 17 (53.1%) cases, biceps
tenotomy or tenodesis in 8 (25%), subscapularis repair in 2 (6.3%), and anterior
stabilization in 2 (6.3%).
Clinical outcomes after last arthroscopic revision rotator cuff repair at final
follow-up are listed in Table 2. A clinically significant improvement was seen
AUGUST 2014 | Volume 37 • Number 8
in the UCLA score of 15.7±3.9 preoperatively to 29.7±4.6 postoperatively
(P<.001). Postoperatively, the authors
noted 8 (25%) excellent, 16 (50%) good,
6 (18.8%) fair, and 2 (6.2%) poor results.
Modified ASES scores improved from
53.4±12.5 preoperatively to 86.7±12.7
postoperatively (P<.001). The standard
mean ASES score was 86.8±12.7 and
did not appear to be statistically different
from out calculated modified ASES score
(P=.580). The VAS pain scores improved
e695
n Feature Article
The only other series to report the results of arthroscopic single-row revision
rotator cuff repair was Lo and Burkhart32
in 2004. They reported on the outcomes of
14 patients with a mean age of 57.9 years
with a mean follow-up of 23.4 months.
Overall patient satisfaction was excellent
(13 of 14 patients), with the mean UCLA
score increasing from 13.1 preoperatively
to 28.6 at last follow-up. The mean shoulder active forward elevation increased
from 120.7° to 153.6° and external rotation increased from 26.1° to 44.3° postoperatively.32
Keener et al.33 also reported their results using various repair techniques on
21 patients (10 single-tendon tears and
11 supraspinatus/infraspinatus tears)
with a mean age of 55.6 years at a mean
follow-up of 33 months. Their study
group showed significant improvements
in all outcome measures, which included
VAS pain scores (6 preoperatively to 3
postoperatively), Simple Shoulder Test
(5 preoperatively to 9 postoperatively),
ASES scores (40 preoperatively to 73
postoperatively), and postoperative range
of motion assessments (P<.05). They also
included postoperative ultrasound to evaluate the integrity of the repair at a mean
follow-up of 25 months, and found that
10 (48%) of the 21 shoulders still had an
intact repair. They found a greater number
of intact repairs in those with an average
age of 51.9 years compared with those
with recurrent tears with an average age of
59.1 years. They also found a significantly
higher re-tear rate in those patients with
tears involving both the supraspinatus and
infraspinatus vs single-tendon tears (73%
vs 30%).33
Piasecki et al34 found similar results
with 54 arthroscopic single- and doublerow repairs at a mean follow-up of 31.1
months. Average age was 54.9 years.
Significant improvements were noted in
ASES scores (43.8 preoperatively to 68.1
postoperatively), Simple Shoulder Test
(3.6 preoperatively to 7.5 postoperatively), VAS pain scores (5.2 preoperatively
e696
Table 2
Comparisons Between Pre- and Postoperative Outcomes for
the Cohort (N=32)
Mean±SD
Outcome Measure
Preoperative
Postoperative
P
AROM forward flexion, deg
146.4±37.3
155.7±16.5
.140
AROM external rotation, deg
50.8±12.5
46.4±17.1
.221
VAS pain score
4.56±1.1
0.906±1.1
<.001
UCLA score
15.7±3.9
29.8±4.6
<.001
NA
86.8±12.7
NA
53.4±12.5
86.7±12.7
<.001
ASES score
Modified ASES
Abbreviations: AROM, active range of motion; ASES, American Shoulder and Elbow
Surgeons; deg, degree; NA, not applicable; UCLA, University California Los Angeles; VAS,
visual analog scale.
Table 3
Analysis of Prognostic Variables Associated With Poor Results
P
UCLA Score
Less Than 28
ASES Score
Less Than 65
≥60 to 64
.296
.566
≥65 to 69
.106
.319
≥70
.012
.254
Female gender
.005
.284
Dominant arm
.038
.279
Tobacco use
1.000
1.000
Workers’ compensation
.254
1.000
>1 prior surgery
.550
1.000
1° (primary) repair: arthroscopic vs open
.220
.600
Complete vs partial repair
.625
1.000
≤36
.685
.600
≤24-35
1.000
1.000
≤12-23
1.000
.550
Massive vs. nonmassive re-tear
1.000
.128
Pain score >5
.685
.600
Preop AROM FF <140º
.152
.039
Preop AROM ER <35º
.047
.025
Variable
Age at last revision, y
Time from last repair to last revision, mo
Abbreviations: AROM, active range of motion; ASES, American Shoulder and Elbow
Surgeons; ER, external rotation; FF, forward flexion; preop, preoperative; UCLA, University
of California Los Angeles.
to 2.6 postoperatively), and active forward
elevation (121° preoperatively to 136°
postoperatively). They found that female
patients and a preoperative abduction less
ORTHOPEDICS | Healio.com/Orthopedics
n Feature Article
than 90° was associated with clinical failure, which they defined as an ASES score
less than 50.34
Finally, in the largest study to date,
Ladermann et al35 reported on the midterm
outcome of mixed single- and doublerow repairs of 21 nonmassive tears and
53 massive tears with a mean follow-up
of 63 months. Overall patient satisfaction
was 78%, with both groups showing significant improvements in active forward
flexion (136° preoperatively to 152° postoperatively), VAS pain scores (5 preoperatively to 2 postoperatively), and UCLA
(17 preoperatively to 26 postoperatively)
and ASES scores (47.1 preoperatively to
75 postoperatively). No significant difference was found between the nonmassive
and massive tear groups regarding functional outcome scores or the need for revision surgery.35
The authors’ current study revealed
similar clinical improvements to the
aforementioned studies; however, without
a direct comparison group of double-row
repairs, the authors cannot draw any conclusions concerning superiority. The patients experienced significantly improved
VAS pain scores from 4.6 to 0.9, UCLA
scores from 15.7 to 29.7, and modified
ASES scores from 53.4 to 86.7 at a mean
follow-up of 70.3 months. This supports
the authors’ belief that correctly performed
single-row arthroscopic revision can provide good to excellent clinical results in
75% of patients based on improvements
in pain and function scores. The authors
believe they can improve on this rate in
the future by excluding patients according
to the prognostic factors elicited in this
study. The authors also performed complete repairs in 81.2% of the patients, yet
their partial repair patients showed similar improvements in clinical outcomes,
perhaps reinforcing the importance of restoring the force couple in the shoulder.
Although the authors found a trend of
improved active forward flexion (146.4°
preoperatively to 155.7° postoperatively),
this did not reach statistical significance
AUGUST 2014 | Volume 37 • Number 8
(P=.140). Active external rotation seemed
to decrease with time (50.8° preoperatively to 46.4° postoperatively; P=.221). This
is most likely due to their selection criteria for revision surgery, which is persistent
shoulder pain, not loss of motion.
Previous authors have noted poorer
postoperative outcomes associated with
patients with recurrent tears after revision
repair,33 female patients, and preoperative
active forward elevation less than 136°, as
well as preoperative VAS score less than
5.34,35 Similarly to these studies, the current study found a poorer outcome for
female patients and those with a preoperative active forward flexion less than 140°.
The authors also found that age older
than 70 years at the time of last revision
surgery, revision involving the dominant
arm, and preoperative active external rotation less than 35° were associated with
a poorer clinical result. Although these
factors may be associated with poorer
outcomes, the authors believe they should
be used as a guide rather than an absolute
contraindication when deciding on whom
to perform revision arthroscopic rotator
cuff repair.
The major limitation of the authors’
current study is the low follow-up rate of
55%, most likely due to the authors’ retrospective study design, the long follow-up
period (up to 165 months), and an older patient population (average age, 69.3 years).
The authors had a small cohort of 32 cases; however, conversely, this is the largest
series studying single-row arthroscopic
revision rotator cuff repair reported in the
literature. In addition, the inherent weaknesses of the functional outcomes scoring
systems themselves (UCLA and ASES
scores) have been described,17 which may
be reflected in the inability to determine
true relationships between factors associated with a poorer result. Follow-up imaging (magnetic resonance image or ultrasound) was not performed as has been
done in other studies due to limitations of
resources.33 The authors are aware that the
re-tear rates are as high as 69% in single-
row primary rotator cuff repairs (tears
>5 cm); however, outcomes do not correlate to this high failure rate.6 Thus, the
authors’ measure for postoperative success was symptomatic relief of pain and
improvement of function. In addition, a
comparison of outcomes between singleand double-row constructs would help to
more clearly define the clinical advantage
of each technique. However, the surgeon
does not perform double-row techniques
for his revision cuff repairs; thus a direct
comparison cannot be made.
Despite these limitations, the current
study provides the longest follow-up (70.3
months) on arthroscopic revision rotator
cuff repairs of any kind in the literature.
In addition, this is the second and largest
case series describing the clinical outcomes of arthroscopic single-row revision
repairs. Furthermore, these data are based
on the clinical experience of a single surgeon using the same surgical techniques
over a span of 12 years. More research on
this topic should be performed in the future; however, currently a clear deficiency
exists in the literature concerning this application of single-row repairs.
Conclusion
The authors’ findings support arthroscopic single-row revision rotator cuff
repair as a viable option for those individuals who present with symptomatic retears after primary repair. Their study has
shown significant improvement in pain
scores and functional scores at a mean
follow-up of 70 months after revision surgery. In addition, the authors described
preoperative factors that make certain patients more likely to fail using the singlerow arthroscopic technique.
References
1. Goutallier D, Postel JM, Bernageau J, Lavau
L, Voisin MC. Fatty muscle degeneration in
cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res.
1994; (304):78-83.
2. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Ar-
e697
n Feature Article
throscopic repair of full-thickness tears of the
supraspinatus: does the tendon really heal. J
Bone Joint Surg Am. 2005; 87:1229-1240.
3. Clement ND, Hallett A, MacDonald D, Howie C, McBirnie J. Does diabetes affect outcome after arthroscopic repair of the rotator
cuff? J Bone Joint Surg Br. 2010; 92:11121117.
4. Tashjian RZ, Deloach J, Green A, Porucznik
CA, Powell AP. Minimal clinically important
differences in ASES and simple shoulder test
scores after nonoperative treatment of rotator cuff disease. J Bone Joint Surg Am. 2010;
92:296-303.
5. Nho SJ, Shindle MK, Adler RS, Warren RF,
Altchek DW, MacGillivray JD. Prospective
analysis of arthroscopic rotator cuff repair:
subgroup analysis. J Shoulder Elbow Surg.
2009; 18:697-704.
6. Duquin TR, Buyea C, Bisson LJ. Which
method of rotator cuff repair leads to the
highest rate of structural healing? A systematic review. Am J Sports Med. 2010; 38:835841.
7. Galatz LM, Ball CM, Teefey SA, Middleton
WD, Yamaguchi K. The outcome and repair
integrity of completely arthroscopically repaired large and massive rotator cuff tears. J
Bone Joint Surg Am. 2004; 86:219-224.
8. Ellman H, Kay SP, Wirth M. Arthroscopic
treatment of full thickness rotator cuff tears:
2 to 7 year follow-up study. Arthroscopy.
1993; 9:195-200.
9. Jost B, Zumstein M, Pfirrmann CW, Gerber
C. Long-term outcome after structural failure
of rotator cuff repairs. J Bone Joint Surg Am.
2006; 88:472-479.
10. Paxton ES, Teefey SA, Dahiya N, Keener
JD, Yamaguchi K, Galatz LM. Clinical and
radiographic outcomes of failed repairs of
large or massive rotator cuff tears: minimum
ten-year follow-up. J Bone J Surg Am. 2013;
95:627-632.
cuff repairs. Arthroscopy. 2011; 27:885-888.
13. Wolf EM, Pennington WT, Agrawal V. Arthroscopic rotator cuff repair: 4- to 10-year
results. Arthroscopy. 2004; 20:5-12.
14. Stuart KD, Karzel RP, Ganjianpour M, Snyder SJ. Long-term outcome for arthroscopic
repair of partial articular-sided supraspinatus
tendon avulsion. Arthroscopy. 2013; 29:818823.
15. Ladermann A, Denard PJ, Burkhart SS. Revision arthroscopic rotator cuff repair: systematic review and authors’ preferred surgical
technique. Arthroscopy. 2012; 28:1160-1169.
16. Ellman H, Hanker G, Bayer M. Repair of the
rotator cuff: end-result study of factors influencing reconstruction. J Bone Joint Surg Am.
1986; 63:1136-1144.
17.Michener LA, McClure PW, Sennett BJ.
American Shoulder and Elbow Surgeons
Standardized Shoulder Assessment Form,
patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow
Surg. 2002; 11:587-594.
18. Tashjian RZ, Hollins AM, Kim H, et al. Factors affecting healing rates after arthroscopic
double-row rotator cuff repair. Am J Sports
Med. 2010; 38:2435-2442.
19. DeOrio JK, Cofield RH. Results of a second
attempt at surgical repair of a failed initial
rotator-cuff repair. J Bone Joint Surg Am.
1984; 66:563-567.
20. Burkhart SS. Arthroscopic treatment of massive rotator cuff tears. Clin Orthop Relat Res.
2001; (390):107-118.
21. Burkhart SS. Arthroscopic repair of massive
rotator cuff tears: concept of margin convergence. Tech Shoulder Elbow Surg. 2000;
1:232-239.
22. Burkhart SS, Nottage WM, Ogilvie-Harris
DJ, Kohn HS, Pachelli A. Partial repair of
irreparable rotator cuff tears. Arthroscopy.
1994; 10:363-370.
11. Slabaugh MA, Nho SJ, Grumet RC, et al.
Does the literature confirm superior clinical results in radiographically healed rotator
cuffs after rotator cuff repair? Arthroscopy.
2010; 26:393-403.
23. Iagulli ND, Field LD, Hobgood ER, Ramsey
JR, Savoie FH III. Comparison of partial versus complete arthroscopic repair of massive
rotator cuff tears. Am J Sports Med. 2012;
40:1022-1026.
12.Marrero LG, Nelman KR, Nottage WM.
Long-term follow-up of arthroscopic rotator
24.Lee E, Bishop JY, Braman JP, Langford
J, Gelber J, Flatow EL. Outcomes after ar-
e698
throscopic rotator cuff repairs. J Shoulder
Elbow Surg. 2007; 16:1-5.
25. Cole BJ, McCarty LP III, Alford W, Lewis
PB, Makda J, Kang R. Arthroscopic rotator
cuff repair: prospective functional outcome
and repair integrity at minimum 2-year
follow-up. J Shoulder Elbow Surg. 2007;
16:579-585.
26. Kamath G, Galatz LM, Keener JD, Teefey S,
Middleton W, Yamaguchi K. Tendon integrity
and functional outcome after arthroscopic
repair of high-grade partial-thickness supraspinatus tears. J Bone Joint Surg Am. 2009;
91:1055-1062.
27. Gartsman GM, Brinker MR, Khan M. Early
effectiveness of arthroscopic repair for fullthickness tears of the rotator cuff: an outcome
analysis. J Bone Joint Surg Am. 1998; 80:3340.
28. Burkhart SS, Danaceau SM, Pearce CE Jr.
Arthroscopic rotator cuff repair: analysis of
results by tear size and by repair technique—
margin convergence versus direct tendon-tobone repair. Arthroscopy. 2001; 17:905-912.
29.Bigliani LU, Cordasco FA, McIlveen SJ,
Musso ES. Operative treatment of failed repairs of the rotator cuff. J Bone Joint Surg
Am. 1992; 74:1505-1515.
30. Neviaser RJ, Neviaser TJ. Reoperation for
failed rotator cuff repair: analysis of fifty cases. J Shoulder Elbow Surg. 1992; 1:283-286.
31. Djurasovic M, Marra G, Arroyo JS, Pollock
RG, Flatow EL, Bigliani LU. Revision rotator cuff repair: factors influencing results. J
Bone Joint Surg Am. 2001; 83:1849-1855.
32. Lo IK, Burkhart SS. Arthroscopic revision
of failed rotator cuff repairs: technique and
results. Arthroscopy. 2004; 20:250-267.
33. Keener JD, Wei AS, Kim HM, et al. Revision
arthroscopic rotator cuff repair: repair integrity and clinical outcome. J Bone Joint Surg
Am. 2010; 92:590-598.
34. Piasecki DP, Verma NN, Nho SJ, et al. Outcomes after arthroscopic revision rotator cuff
repair. Am J Sports Med. 2010; 38:40-46.
35. Ladermann A, Denard PJ, Burkhart SS. Midterm outcome of arthroscopic revision repair
of massive and non-massive rotator cuff
tears. Arthroscopy. 2011; 27:1620-1627.
ORTHOPEDICS | Healio.com/Orthopedics