On the faculty
Dr Kenneth Cutbush was invited onto the faculty of the Royal North Shore Shoulder Symposium. The meeting, held in Sydney in February 2020, drew over 100 Australian shoulder surgeons.
Being invited onto the faculty of a meeting means being asked to teach rather than simply to attend. Faculty members give the formal presentations, chair sessions and take part in the panel discussions where cases are argued over.
What a failed rotator cuff repair means
The rotator cuff is the group of four tendons that hold the ball of the shoulder in its socket and rotate the arm. A repair reattaches a torn tendon to its footprint on the bone, usually through keyhole portals, using anchors placed in the bone and sutures passed through the tendon. The tendon then has to heal back onto bone while the shoulder is protected.
A repair is described as failed when the tendon does not heal, or heals and then tears again, or when the shoulder stays painful and weak even though the imaging looks acceptable. By that stage the tendon may have retracted, the muscle may have wasted and been partly replaced by fat, and the joint surfaces may have worn. Those findings are what determine whether anything further can be reconstructed. Individual results vary.
The subject
A proportion of the patients seen in this practice are people who did not recover well after rotator cuff surgery, and who have often been told that nothing further can be done. That is frequently not the case, though the options depend a great deal on what remains of the tendon and muscle and on the state of the joint.
The presentation set out an algorithm for approaching these shoulders: a structured way of working through what has failed, what is reconstructable, and what the realistic options are. A failed cuff repair can leave people unable to sleep or to work, which is why it is worth having a considered approach rather than treating it as a dead end.
Not every option is surgical, and for some shoulders continued non-surgical management is the right answer. Individual results vary.
Related information
- Our rotator cuff tear and rotator cuff repair pages
- Our rehabilitation page
- Our post on the failed rotator cuff, which is the introduction to this talk