RECCURENT TEAR AFTER REPAIRING A ROTATOR CUFF TEAR: RESULTS AFTER NEW SURGERY? 38 CASES

Abstract

Purpose: The goal of this retrospective study was to analyze the results of each kind of reoperation used in rotator cuff retear.

Materials and Methods: 38 rotator cuff retear were reoperated. 18 female and 20 male with a mean age was 57(range 40 to 73 years). Initial tear were repaired by open surgery with a procedure of trans osseous reinsertion in 26 cases. Arthro CT Scan, confirmed the recurrent tear and evaluated the size, number of tendon involved and the global fatty degeneration index (GFDI) of the muscle.The size of the retear was smaller in 9 patients, same in 5 and bigger in 23 with always a decreasing of the GFDI from 0.83 to 1.60. The mean time of reoperation was 29 months(range 1 to 120). We performed 14 trans osseous reinsertion, 6 latero lateral tendinous suture, 3 resection reinsertion, 5 deltoid flap, 3 latissimus dorsi flap, 4 reversed prosthesis, one arthrodesis, one subscapularis flap and one debridment for acute infection. A biceps tenodesis were performed in 20 cases.

Results: Results were evaluated with a mean follow-up of 33 months (range 5 to 145). The constant’s score improved from 46(22 to 68) preoperatively to 67(40–95) post operatively with a decreasing of the GFDI in 0.83 to 1.60. The best results were obtained with a trans osseous reinsertion (Constant’s score 70; gain 40%) and latero lateral tendinous suture(Constant’s score 78; gain 37%). However, the gain higher was obtained with the reversed prosthesis(Constant’s score 57;gain 88%).

Discussion and Conclusion: Arthro CT Scan is a good way to diagnose a recurrent rotator cuff tear and to choose the type of new operation when shoulder still painfull. The final result is higher if it is possible to do a transosseous reinsertion for a small retear with a good trophicity of the muscle (GFDI lower). However for pseudo paralytic shoulder, reversed prosthesis can improved the constant’s score from 34 to 64 with a restoration of a good elevation. Latissimus dorsi flap (deltoid and subscapularis flap) are usefull for painrelief but the improvement of motion is less.