Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Departments of Family Medicine and Orthopaedics, Hershey, PA conks@pennstatehealth.psu.edu
The authors reported no potential conflict of interest relevant to this article.
Pain, function, and patient satisfaction outcomes following rotator cuff repair are generally favorable: 90% of patients are “happy” 6 months postop.28 Younger populations often have traumatic rotator cuff tears; they generally are interested in returning to sporting activities following their injury. Nearly 85% of younger patients who undergo rotator cuff repair return to sports, and 65.9% return to an equivalent level of play.36
Variables associated with an unfavorable outcome include increasing age, smoking, increased size of the tear, poor tendon quality, hyperlipidemia, workers’ compensation status, fatty infiltration of muscle, obesity, diabetes, and additional procedures to the biceps tendon and acromioclavicular joint performed at the time of rotator cuff repair.37-39 Interestingly, a study concluded that, if a patient expects a good surgical outcome, they are more likely to go on to report a favorable outcome—suggesting that a patient’s expectations might influence their actual outcome.40
Risks and complications
Although rotator cuff surgery has much lower morbidity than other orthopedic surgeries, it is not without risk of complications. If re-tears are excluded, postop complications have been reported in approximately 10% of patients.41 Common complications and their anticipated rate of occurrence are listed in TABLE 2.42-49
Re-tear of the surgically repaired tendon is the most common postop complication. Published re-tear rates range from 20% to 96%42,43 and generally correlate with initial tear size: A small tear is twice as likely to heal as a massive tear.50 That large range—a span of 76%—results from using a variety of methods to measure re-tear and might not have clinical meaning. A meta-analysis that examined more than 8000 shoulder surgeries reported an overall re-tear rate of 26.6%; however, both patients whose tendons healed and those who re-tore demonstrated clinical improvement.51 In a separate study, patients reported improvement in pain, function, range of motion, and satisfaction regardless of the integrity of the tendon; however, significant improvement in strength was seen only in those whose repair had healed.52
Postop stiffness is more common with arthroscopic repair than with open surgery, and with smaller rather than larger tears.53 Patient variables associated with an increased risk of postop adhesive capsulitis include workers’ compensation insurance, age < 50 years, and preoperative calcific tendonitis or adhesive capsulitis.53 Stiffness generally responds to physical therapy and rarely requires surgical lysis of adhesions or capsular release.
