Technical Note
Medial Rotator Cuff Failure After Arthroscopic Double-Row Rotator Cuff Repair

https://doi.org/10.1016/j.arthro.2008.03.009Get rights and content

Abstract

Persistent tendon defects after rotator cuff repair are not uncommon. Recently, the senior author has identified a subset of 5 patients (mean age, 52 years; range, 42 to 59 years) after arthroscopic double-row rotator cuff repair who showed an unusual mechanism of tendon failure. In these patients the tendon footprint appears well fixed to the greater tuberosity with normal thickness. However, medial to the intact footprint, the tendon is torn with full-thickness defects through the rotator cuff. All patients were involved in Workers' Compensation claims. Magnetic resonance arthrography showed an intact cuff footprint but dye leakage in all patients. Revision surgery was performed at a mean of 8.6 months after the index procedure and showed an intact rotator cuff footprint but cuff failure medial to the footprint. Four patients had repair of the defects by tendon-to-tendon side-to-side sutures, whereas one did not undergo repair. Medial-row failure of the rotator cuff is a previously unreported mechanism of failure after double-row rotator cuff repair. Given the small number of patients in this study, it is unclear whether these defects are symptomatic. However, repair of these defects resulted in improvement in pain in 4 of 5 patients.

Section snippets

Case Series

From March 2003 to March 2006, the senior author noted medial rotator cuff failure in 5 patients who had previously had an arthroscopic double-row rotator cuff repair. The medial rotator cuff failure was ultimately diagnosed at repeat arthroscopy in all 5 cases. The mean age of this group of patients was 52 years (range, 42 to 59 years). Two were men and three were women. The dominant limb was involved in all cases. All of these patients were Workers' Compensation patients. All had previously

Discussion

To our knowledge, the pattern of medial cuff failure of arthroscopic double-row rotator cuff repair observed in this group of patients has not previously been reported. Its relation to ongoing pain and hence its ideal mode of treatment are unclear in this small group of patients.

There are numerous biomechanical and clinical reports evaluating various rotator cuff repair constructs and analyzing their potential mechanisms of failure. The commonly cited mechanism of failure in most reports is

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I.K.Y.L. has received financial support from Arthrex related to the subject of this manuscript. The other authors report no conflict of interest.

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