Review Question - QID 4412

Patient age older than 65 is the highest risk factor for nonhealing of the surgically repaired rotator cuff.

Relative surgical indications for rotator cuff tears include acute (<3 months from time of injury), traumatic tears in patients younger than age 60 years old. Additionally, full-thickness and partial-thickness rotator cuff tears that fail nonsurgical treatment are relative indications for surgical intervention. Advanced fatty infiltration and muscle atrophy as detected on MRI and significant glenohumeral arthritis are relative contraindications for rotator cuff repair.

Boileau et al. investigated 65 patients with chronic rotator cuff tears. They determined that patients over the age of sixty-five years (p = 0.001) and patients with associated delamination of the subscapularis and/or the infraspinatus (p = 0.02) have significantly lower rates of healing.

Bishop et al. performed a study of 72 patients with rotator cuff tears that either underwent open or arthroscopic rotator cuff repair. They found that arthroscopic and open repairs had similar rates of healing in tears <3cm in size with the arthroscopic group having greater strength of elevation and external rotation. However, they also found that in tears >3cm in size, that open repair conferred better healing rates than arthroscopic repair.

Figure A is an arthroscopic photo of a U-shaped rotator cuff tear as viewed from a lateral portal while in the subacromial space. The rotator cuff tendon is retracted off of the footprint with humeral head articular surface exposed, the glenoid seen in the distance, and the biceps tendon seen along the right edge of the tear. Illustration A shows the same view after a rotator cuff repair using a trans-osseous equivalent suture bridge construct.