Complications in Posterosuperior and Three Tendon Rotator Cuff Repair

  • Stefan PaulyEmail author
  • Markus Scheibel


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)


Rotator cuff Complication Shoulder arthroscopy Infection Low-grade infection Stiffness Anchor loosening Re-tear 


  1. 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. 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.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.PubMedGoogle Scholar
  8. 8.
    Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008;39:1338–44.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Brislin KJ, Field LD, Savoie FH 3rd. Complications after arthroscopic rotator cuff repair. Arthroscopy. 2007;23:124–8.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Itoi E, Nagamoto H, Sano H, et al. Deadman theory revisited12. Biomed Mater Eng. 2016;27:171–81.PubMedPubMedCentralGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. 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.CrossRefGoogle Scholar
  32. 32.
    Hyatt AE, Lavery K, Mino C, et al. Suture anchor biomechanics after rotator cuff footprint decortication. Arthroscopy. 2016;32:544–50.CrossRefGoogle Scholar
  33. 33.
    Burkhart SS. The deadman theory of suture anchors: observations along a south Texas fence line. Arthroscopy. 1995;11:119–23.CrossRefGoogle Scholar
  34. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Skaliczki G, Paladini P, Merolla G, et al. Early anchor displacement after arthroscopic rotator cuff repair. Int Orthop. 2015;39:915–20.CrossRefGoogle Scholar
  36. 36.
    Desai VS, Southam BR, Grawe B. Complications following arthroscopic rotator cuff repair and reconstruction. JBJS Rev. 2018;6:e5.CrossRefGoogle Scholar
  37. 37.
    Atesok K, Macdonald P, Leiter J, et al. Postoperative deep shoulder infections following rotator cuff repair. World J Orthop. 2017;8:612–8.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 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.CrossRefGoogle Scholar
  39. 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.CrossRefGoogle Scholar
  40. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Masini BD, Stinner DJ, Waterman SM, et al. Bacterial adherence to high-tensile strength sutures. Arthroscopy. 2011;27:834–8.CrossRefGoogle Scholar
  42. 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.CrossRefGoogle Scholar
  43. 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.CrossRefGoogle Scholar
  44. 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.CrossRefGoogle Scholar
  45. 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.PubMedGoogle Scholar
  46. 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.CrossRefGoogle Scholar
  47. 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.CrossRefGoogle Scholar
  48. 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.CrossRefGoogle Scholar
  49. 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.CrossRefGoogle Scholar
  50. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 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.CrossRefGoogle Scholar
  56. 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.CrossRefGoogle Scholar
  57. 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.CrossRefGoogle Scholar
  58. 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.CrossRefGoogle Scholar
  59. 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.CrossRefGoogle Scholar
  60. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Scheibel M. Recurrent defects of the rotary cuff: causes and therapeutic strategies. Oper Orthop Traumatol. 2012;24:458–67.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Yamakado K, Katsuo S, Mizuno K, et al. Medial-row failure after arthroscopic double-row rotator cuff repair. Arthroscopy. 2010;26:430–5.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 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.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department for Special Orthopaedics and Trauma SurgeryVivantes AVKBerlinGermany
  2. 2.Center for Musculoskeletal SurgeryCharité Universitaetsmedizin BerlinBerlinGermany
  3. 3.Schulthess ClinicZurichSwitzerland

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