Is rotator cuff operation better now than it was 10 years ago?
Physical Therapy in Seattle for Shoulder
Q: My sister had a rotator cuff repair 10 years ago and had a rough time of it. The tear reopened after surgery and she ended up having two more operations. Now I find myself in the same position of needing rotator cuff surgery. Is there any chance things are better now that another decade has passed -- maybe safer, better ways of doing the operation? I definitely don't want to go through what she has.
Surgery for the shoulder has changed over the years. A wide incision and open surgery has given way now to minimally invasive procedures using arthroscopic techniques. Arthroscopic approaches can be all-arthroscopic or arthroscopic combined with a small incision called mini-open.
A: Even the type of sutures used has evolved from single-row repairs to double-row stitches. Among suture techniques there's the transosseous, single-row suture anchor, combined transosseous/suture anchor, double-row suture anchor, and suture bridge to choose from. Some of these techniques were first introduced and studied just in the last 5 years.
Surgeons have found that the repair method affects the structural healing rate. In a systematic review of 23 studies where MRIs were used to see how well the healing was coming along, patients repaired with the double-row technique had the best results with the lowest rate of retears. It seems the double-row suture improves the biomechanical performance and contact area and pressure of the healing tissue. The double-row technique also applies less tension to the healing tissue, which is important during the rehab phase after surgery.
Experienced surgeons get the most consistent results. In the case of double-row sutures, the technique requires more extensive releases of the surrounding soft tissue. Getting the right tension on the healing tissue can be a fine art. There is evidence that selecting a surgeon who has done a large number of these procedures in a hospital that also reports a high volume of surgeries yields the best overall results.
Reference: Thomas R. Duquin, MD, et al. Which Method of Rotator Cuff Repair Leads to the Highest Rate of Structural Healing. A Systematic Review. In The American Journal of Sports Medicine. April 2010. Vol. 38. No. 4. Pp. 835-841.