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Complications in Posterosuperior and Three Tendon Rotator Cuff Repair

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Complications in Arthroscopic Shoulder Surgery

Abstract

Arthroscopic rotator cuff (RC) repair is a well-accepted and reliable procedure with a generally low morbidity profile. Nonetheless, it is associated with general and specific intra- and postoperative complications that have to be addressed and managed. Knowledge of such complications is the key to their prevention and seems just as relevant as successful revision strategies are.

Given the tremendous number of studies reporting on several techniques and results of arthroscopic rotator cuff repair over the past 10–15 years, there is a relative paucity of reports on problems and complications after shoulder arthroscopy. Focused on shoulder arthroscopy in general, this rate was summarized 5–10%, including infection, stiffness, instrument breakage, hardware failure, direct nerve injury, fluid extravasation and deep venous thrombosis (Brislin et al., Arthroscopy 23:124–128, 2007). Even fewer papers focused on specific complications following RC repair. Among those, one of the first reports provided a specific complication rate of 10.6%, which is analyzed later in detail (Brislin et al., Arthroscopy 23:124–128, 2007). Back in 2007, the authors concluded a comparable complication rate between ASC and open RC repair techniques.

This present chapter will assess this information on its current value and browse through certain RC-repair specific complications in order to minimize their incidence.

Ahead, one central problem with this regard is the lack of a valid definition of a (surgical) complication. What can be considered (yet) normal) in the postoperative course following RC repair, such as temporary or prolonged stiffness, and where does a complication begin? The literature does not consistently report on dedicated complications after RC repair, which hinders objective comparison of the incidence of these adverse events (Audige et al., Orthop J Sports Med 3, 2015)

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Change history

  • 24 April 2020

    This book was inadvertently published with incorrect Author name as Stefan Pauly and now it is corrected as Stephan Pauly at every occurrence in the Book.

References

  1. Goutallier D, Postel JM, Bernageau J, et al. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994:78–83.

    Google Scholar 

  2. Fuchs B, Weishaupt D, Zanetti M, et al. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg. 1999;8:599–605.

    Article  CAS  PubMed  Google Scholar 

  3. Gladstone JN, Bishop JY, Lo IK, et al. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med. 2007;35:719–28.

    Article  PubMed  Google Scholar 

  4. Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003;12:550–4.

    Article  PubMed  Google Scholar 

  5. Shen PH, Lien SB, Shen HC, et al. Long-term functional outcomes after repair of rotator cuff tears correlated with atrophy of the supraspinatus muscles on magnetic resonance images. J Shoulder Elbow Surg. 2008;17:1S–7S.

    Article  PubMed  Google Scholar 

  6. Meyer DC, Farshad M, Amacker NA, et al. Quantitative analysis of muscle and tendon retraction in chronic rotator cuff tears. Am J Sports Med. 2012;40:606–10.

    Article  PubMed  Google Scholar 

  7. Boileau P, Brassart N, Watkinson DJ, et al. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87:1229–40.

    PubMed  Google Scholar 

  8. Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008;39:1338–44.

    Article  PubMed  Google Scholar 

  9. Defranco MJ, Bershadsky B, Ciccone J, et al. Functional outcome of arthroscopic rotator cuff repairs: a correlation of anatomic and clinical results. J Shoulder Elbow Surg. 2007;16:759–65.

    Article  PubMed  Google Scholar 

  10. Grasso A, Milano G, Salvatore M, et al. Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. Arthroscopy. 2009;25:4–12.

    Article  PubMed  Google Scholar 

  11. Milgrom C, Schaffler M, Gilbert S, et al. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br. 1995;77:296–8.

    Article  CAS  PubMed  Google Scholar 

  12. Sorensen AK, Bak K, Krarup AL, et al. Acute rotator cuff tear: do we miss the early diagnosis? A prospective study showing a high incidence of rotator cuff tears after shoulder trauma. J Shoulder Elbow Surg. 2007;16:174–80.

    Article  PubMed  Google Scholar 

  13. Yamaguchi K, Ditsios K, Middleton WD, et al. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 2006;88:1699–704.

    Article  PubMed  Google Scholar 

  14. Cho NS, Lee BG, Rhee YG. Arthroscopic rotator cuff repair using a suture bridge technique: is the repair integrity actually maintained? Am J Sports Med. 2011;39:2108–16.

    Article  PubMed  Google Scholar 

  15. Gumina S, Carbone S, Campagna V, et al. The impact of aging on rotator cuff tear size. Musculoskelet Surg. 2013;97(Suppl 1):69–72.

    Article  PubMed  Google Scholar 

  16. Kamath G, Galatz LM, Keener JD, et al. Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears. J Bone Joint Surg Am. 2009;91:1055–62.

    Article  PubMed  Google Scholar 

  17. Flurin PH, Hardy P, Abadie P, et al. Rotator cuff tears after 70 years of age: a prospective, randomized, comparative study between decompression and arthroscopic repair in 154 patients. Orthop Traumatol Surg Res. 2013;99:S371–8.

    Article  PubMed  Google Scholar 

  18. Pauly S, Stahnke K, Klatte-Schulz F, et al. Do patient age and sex influence tendon cell biology and clinical/radiographic outcomes after rotator cuff repair? Am J Sports Med. 2015;43:549–56.

    Article  PubMed  Google Scholar 

  19. Robinson PM, Wilson J, Dalal S, et al. Rotator cuff repair in patients over 70 years of age: early outcomes and risk factors associated with re-tear. Bone Joint J. 2013;95-B:199–205.

    Article  CAS  PubMed  Google Scholar 

  20. Verma NN, Bhatia S, Baker CL 3rd, et al. Outcomes of arthroscopic rotator cuff repair in patients aged 70 years or older. Arthroscopy. 2010;26:1273–80.

    Article  PubMed  Google Scholar 

  21. Chung SW, Oh JH, Gong HS, et al. Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors. Am J Sports Med. 2011;39:2099–107.

    Article  PubMed  Google Scholar 

  22. Osti L, Papalia R, Del Buono A, et al. Comparison of arthroscopic rotator cuff repair in healthy patients over and under 65 years of age. Knee Surg Sports Traumatol Arthrosc. 2010;18:1700–6.

    Article  PubMed  Google Scholar 

  23. Tashjian RZ, Hollins AM, Kim HM, et al. Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med. 2010;38:2435–42.

    Article  PubMed  Google Scholar 

  24. Day M, Westermann R, Duchman K, et al. Comparison of short-term complications after rotator cuff repair: open versus arthroscopic. Arthroscopy. 2018;34:1130–6.

    Article  PubMed  Google Scholar 

  25. Owens BD, Williams AE, Wolf JM. Risk factors for surgical complications in rotator cuff repair in a veteran population. J Shoulder Elbow Surg. 2015;24:1707–12.

    Article  PubMed  Google Scholar 

  26. Schairer WW, Nwachukwu BU, Fu MC, et al. Risk factors for short-term complications after rotator cuff repair in the united states. Arthroscopy. 2018;34:1158–63.

    Article  PubMed  Google Scholar 

  27. Yeranosian MG, Arshi A, Terrell RD, et al. Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery. Am J Sports Med. 2014;42:437–41.

    Article  PubMed  Google Scholar 

  28. Brislin KJ, Field LD, Savoie FH 3rd. Complications after arthroscopic rotator cuff repair. Arthroscopy. 2007;23:124–8.

    Article  PubMed  Google Scholar 

  29. Itoi E, Nagamoto H, Sano H, et al. Deadman theory revisited12. Biomed Mater Eng. 2016;27:171–81.

    CAS  PubMed  Google Scholar 

  30. Clavert P, Bouchaib J, Sommaire C, et al. Does bone density of the greater tuberosity change in patients over 70? Orthop Traumatol Surg Res. 2014;100:109–11.

    Article  CAS  PubMed  Google Scholar 

  31. Cadet ER, Hsu JW, Levine WN, et al. The relationship between greater tuberosity osteopenia and the chronicity of rotator cuff tears. J Shoulder Elbow Surg. 2008;17:73–7.

    Article  PubMed  Google Scholar 

  32. Hyatt AE, Lavery K, Mino C, et al. Suture anchor biomechanics after rotator cuff footprint decortication. Arthroscopy. 2016;32:544–50.

    Article  PubMed  Google Scholar 

  33. Burkhart SS. The deadman theory of suture anchors: observations along a south Texas fence line. Arthroscopy. 1995;11:119–23.

    Article  CAS  PubMed  Google Scholar 

  34. Nagra NS, Zargar N, Smith RD, et al. Mechanical properties of all-suture anchors for rotator cuff repair. Bone Joint Res. 2017;6:82–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Skaliczki G, Paladini P, Merolla G, et al. Early anchor displacement after arthroscopic rotator cuff repair. Int Orthop. 2015;39:915–20.

    Article  PubMed  Google Scholar 

  36. Desai VS, Southam BR, Grawe B. Complications following arthroscopic rotator cuff repair and reconstruction. JBJS Rev. 2018;6:e5.

    Article  PubMed  Google Scholar 

  37. Atesok K, Macdonald P, Leiter J, et al. Postoperative deep shoulder infections following rotator cuff repair. World J Orthop. 2017;8:612–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Heyer JH, Kuang X, Amdur RL, et al. Identifiable risk factors for thirty-day complications following arthroscopic rotator cuff repair. Phys Sportsmed. 2018;46:56–60.

    Article  PubMed  Google Scholar 

  39. Kosinski LR, Gil JA, Durand WM, et al. 30-Day readmission following outpatient rotator cuff repair: an analysis of 18,061 cases. Phys Sportsmed. 2018;46:466–70.

    Article  PubMed  Google Scholar 

  40. Audige L, Blum R, Muller AM, et al. Complications following arthroscopic rotator cuff tear repair: a systematic review of terms and definitions with focus on shoulder stiffness. Orthop J Sports Med. 2015;3:2325967115587861.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Masini BD, Stinner DJ, Waterman SM, et al. Bacterial adherence to high-tensile strength sutures. Arthroscopy. 2011;27:834–8.

    Article  PubMed  Google Scholar 

  42. Brady PC, Arrigoni P, Burkhart SS. Evaluation of residual rotator cuff defects after in vivo single- versus double-row rotator cuff repairs. Arthroscopy. 2006;22:1070–5.

    Article  PubMed  Google Scholar 

  43. Mazzocca AD, Millett PJ, Guanche CA, et al. Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med. 2005;33:1861–8.

    Article  PubMed  Google Scholar 

  44. Meier SW, Meier JD. Rotator cuff repair: the effect of double-row fixation on three-dimensional repair site. J Shoulder Elbow Surg. 2006;15:691–6.

    Article  PubMed  Google Scholar 

  45. Ma CB, Comerford L, Wilson J, et al. Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation. J Bone Joint Surg Am. 2006;88:403–10.

    PubMed  Google Scholar 

  46. Meier SW, Meier JD. The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study. Arthroscopy. 2006;22:1168–73.

    Article  PubMed  Google Scholar 

  47. Pauly S, Fiebig D, Kieser B, et al. Biomechanical comparison of four double-row speed-bridging rotator cuff repair techniques with or without medial or lateral row enhancement. Knee Surg Sports Traumatol Arthrosc. 2011;19:2090–7.

    Article  PubMed  Google Scholar 

  48. Pauly S, Kieser B, Schill A, et al. Biomechanical comparison of 4 double-row suture-bridging rotator cuff repair techniques using different medial-row configurations. Arthroscopy. 2010;26:1281–8.

    Article  PubMed  Google Scholar 

  49. Smith CD, Alexander S, Hill AM, et al. A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am. 2006;88:2425–31.

    Article  PubMed  Google Scholar 

  50. Waltrip RL, Zheng N, Dugas JR, et al. Rotator cuff repair. A biomechanical comparison of three techniques. Am J Sports Med. 2003;31:493–7.

    Article  PubMed  Google Scholar 

  51. Chen M, Xu W, Dong Q, et al. Outcomes of single-row versus double-row arthroscopic rotator cuff repair: a systematic review and meta-analysis of current evidence. Arthroscopy. 2013;29:1437–49.

    Article  PubMed  Google Scholar 

  52. Dehaan AM, Axelrad TW, Kaye E, et al. Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review. Am J Sports Med. 2012;40:1176–85.

    Article  PubMed  Google Scholar 

  53. Pauly S, Gerhardt C, Chen J, et al. Single versus double-row repair of the rotator cuff: does double-row repair with improved anatomical and biomechanical characteristics lead to better clinical outcome? Knee Surg Sports Traumatol Arthrosc. 2010;18:1718–29.

    Article  PubMed  Google Scholar 

  54. Perser K, Godfrey D, Bisson L. Meta-analysis of clinical and radiographic outcomes after arthroscopic single-row versus double-row rotator cuff repair. Sports Health. 2011;3:268–74.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Prasathaporn N, Kuptniratsaikul S, Kongrukgreatiyos K. Single-row repair versus double-row repair of full-thickness rotator cuff tears. Arthroscopy. 2011;27:978–85.

    Article  PubMed  Google Scholar 

  56. Saridakis P, Jones G. Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review. J Bone Joint Surg Am. 2010;92:732–42.

    Article  PubMed  Google Scholar 

  57. Sheibani-Rad S, Giveans MR, Arnoczky SP, et al. Arthroscopic single-row versus double-row rotator cuff repair: a meta-analysis of the randomized clinical trials. Arthroscopy. 2013;29:343–8.

    Article  PubMed  Google Scholar 

  58. Denard PJ, Jiwani AZ, Ladermann A, et al. Long-term outcome of arthroscopic massive rotator cuff repair: the importance of double-row fixation. Arthroscopy. 2012;28:909–15.

    Article  PubMed  Google Scholar 

  59. Duquin TR, Buyea C, Bisson LJ. Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review. Am J Sports Med. 2010;38:835–41.

    Article  PubMed  Google Scholar 

  60. Xu C, Zhao J, Li D. Meta-analysis comparing single-row and double-row repair techniques in the arthroscopic treatment of rotator cuff tears. J Shoulder Elbow Surg. 2014;23:182–8.

    Article  PubMed  Google Scholar 

  61. Zhang Q, Ge H, Zhou J, et al. Single-row or double-row fixation technique for full-thickness rotator cuff tears: a meta-analysis. PLoS One. 2013;8:e68515.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Mccarron JA, Derwin KA, Bey MJ, et al. Failure with continuity in rotator cuff repair “healing”. Am J Sports Med. 2013;41:134–41.

    Article  PubMed  Google Scholar 

  63. Scheibel M. Recurrent defects of the rotary cuff: causes and therapeutic strategies. Oper Orthop Traumatol. 2012;24:458–67.

    Article  CAS  PubMed  Google Scholar 

  64. Hayashida K, Tanaka M, Koizumi K, et al. Characteristic retear patterns assessed by magnetic resonance imaging after arthroscopic double-row rotator cuff repair. Arthroscopy. 2012;28:458–64.

    Article  PubMed  Google Scholar 

  65. Trantalis JN, Boorman RS, Pletsch K, et al. Medial rotator cuff failure after arthroscopic double-row rotator cuff repair. Arthroscopy. 2008;24:727–31.

    Article  PubMed  Google Scholar 

  66. Yamakado K, Katsuo S, Mizuno K, et al. Medial-row failure after arthroscopic double-row rotator cuff repair. Arthroscopy. 2010;26:430–5.

    Article  PubMed  Google Scholar 

  67. Charousset C, Bellaiche L, Kalra K, et al. Arthroscopic repair of full-thickness rotator cuff tears: is there tendon healing in patients aged 65 years or older? Arthroscopy. 2010;26:302–9.

    Article  PubMed  Google Scholar 

  68. Kim KC, Shin HD, Lee WY. Repair integrity and functional outcomes after arthroscopic suture-bridge rotator cuff repair. J Bone Joint Surg Am. 2012;94:e48.

    Article  PubMed  Google Scholar 

  69. Russell RD, Knight JR, Mulligan E, et al. Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. J Bone Joint Surg Am. 2014;96:265–71.

    Article  PubMed  Google Scholar 

  70. Slabaugh MA, Nho SJ, Grumet RC, et al. Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair? Arthroscopy. 2010;26:393–403.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department for Special Orthopaedics and Trauma Surgery, Vivantes AVK, Berlin, Germany

    Stephan Pauly

  2. Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany

    Stephan Pauly & Markus Scheibel

  3. Schulthess Clinic, Zurich, Switzerland

    Markus Scheibel

Authors
  1. Stephan Pauly
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  2. Markus Scheibel
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Correspondence to Stephan Pauly .

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Editors and Affiliations

  1. Department of Orthopedics, Clinique Générale, Annecy, France

    Laurent Lafosse

  2. Gelenkchirurgie Orthopädie Hannover, Hannover, Germany

    Jens Agneskirchner

  3. Department of Orthopedics, Clinique Générale, Annecy, France

    Thibault Lafosse

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Pauly, S., Scheibel, M. (2020). Complications in Posterosuperior and Three Tendon Rotator Cuff Repair. In: Lafosse, L., Agneskirchner, J., Lafosse, T. (eds) Complications in Arthroscopic Shoulder Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-24574-0_8

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  • DOI: https://doi.org/10.1007/978-3-030-24574-0_8

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