Speaking on an unsolved problem
Dr Kenneth Cutbush spoke at the Royal North Shore Hospital Symposium on rotator cuff repairs and on ways of increasing the success rate of those repairs.
How often repairs fail to heal
Published series, including several large international studies, report retear rates of 30 to 40% after rotator cuff repair surgery. Individual results vary, and the figure relevant to any particular shoulder depends heavily on the factors below rather than on an average.
This is a striking number, and it is not usually what patients expect to hear. Dr Cutbush's view on it is blunt:
"I don't think I would want to be a patient undergoing an operation with a 40% failure rate."
Better ways of repairing these tears are needed, and that is the reason for the research effort directed at the problem.
What influences whether a repair heals
Retear is not random. The factors generally recognised as influencing whether a repaired tendon heals to bone include the size of the original tear, how far the tendon has retracted, the quality of the tendon and the degree of muscle wasting and fatty change, the quality of the bone the anchors are placed into, the patient's age, smoking, and diabetes. How closely the post-operative programme is followed also matters.
Importantly, a repair that does not heal completely is not automatically a poor result. Many people whose repairs are shown on imaging to have retorn are nonetheless considerably more comfortable and more functional than they were before surgery. Equally, not every cuff tear needs repairing in the first place: many people do well with a non-surgical programme, and that is a legitimate option worth discussing.
Where the research is directed
Efforts to improve healing rates focus on the biology as much as the mechanics: how the repair is configured and tensioned, the fixation used, and methods of improving the biological environment at the tendon-to-bone interface so that the repair has a better chance of healing rather than simply being held together.
With thanks
With thanks to Ben Cass and Allan Young for organising the meeting and for the invitation to speak.
Related information
See our pages on rotator cuff tear and rotator cuff repair, and our posts on rehabilitation after a rotator cuff repair and the failed rotator cuff.