Abstract
A healed rotator cuff repair results in a superior outcome for the patient compared
with a non-healed repair. The surgeon can maximize the chance of a healed repair by
knowing the end-point of each key step in the repair process and adhering to a few
core principles. First, the rotator cuff tear pattern (e.g. crescent, L-tear, reverse
L-tear, U-tear) must be recognized, starting with careful assessment of preoperative
MRI but concluding with the arthroscopic assessment of tear edge mobility. Second,
a low-tension, anatomic, and mechanically robust repair construct (e.g. linked, double
row; load-sharing rip stop; margin convergence to bone) must be determined based on
the tear pattern. Increasingly, surgeons are recognizing the importance of the superior
capsule of the shoulder, which can appear as a separate pathoanatomic structure in
a delaminated rotator cuff tear and require independent suturing in the repair construct.
Third, the biological healing capacity of the repair site must be optimized by using
meticulous preparation of the greater tuberosity bone, including removal of soft tissue
remnants, light burring, and creation of bone vents. Finally, avoid aggressive early
rehabilitation after arthroscopic rotator cuff repair respecting that tendon to bone
healing is unlikely to occur before 12 weeks postoperatively. Sling immobilization
and judicious use of early passive motion should be used for the first 6 weeks, with
passive shoulder range of motion performed during weeks 6-12 postoperatively. Rotator
cuff strengthening, and active overhead use of the arm should be delayed until at
least 12 weeks after surgery to minimize the risk of retear.
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Article info
Publication history
Accepted:
November 6,
2018
Received:
August 21,
2018
Footnotes
The authors report the following conflicts of interest or sources of funding: R.H. reports payments for lectures and patents from Arthrex, and royalties from Wolters-Kluwer. S.S.B. reports payments for consultancy and patents from Arthrex, and royalties from Arthrex and Wolters-Kluwer. Full ICMJE author disclosure forms are available for article online, as supplementary material.
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Copyright
© 2018 Published by Elsevier on behalf of the Arthroscopy Association of North America