When is surgical intervention indicated for the treatment of rotator cuff injuries?

Updated: Oct 25, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Indications for operative treatment of rotator cuff disease include partial-thickness or full-thickness tears in an active individual who does not have improved pain and/or function within 3-6 months with a supervised rehabilitation program. An acromioplasty is usually performed in the presence of a type II (curved) or type III (hooked) acromion with an associated rotator cuff tear. Athletes with rotator cuff pathology secondary to GH instability also need to have this addressed. Surgical treatment of a shoulder rotator cuff injury is reliable, and it provides good clinical results in patients who were operated on within the first 3 weeks after the injury. [29]

In surgical candidates, early repair is useful to avoid fatty degeneration and retraction of the remnant rotator cuff musculature. Functional recovery should be stressed, and, in a patient who can achieve pain-free activities of daily living in the setting of a rotator cuff tear, surgical repair may be avoided. Surgeries including muscle transfers and debridement are generally reserved for massive, irreparable rotator cuff tears. A latissimus dorsi tendon transfer is one type of treatment for irreparable rotator cuff tears that has demonstrated improvement in shoulder function, range of motion, strength, and pain relief. [30]

Attempts to enhance healing in rotator cuff repair have included the use of platelet-rich fibrin matrix applied to the tendon-bone interface at the time of rotator cuff repair; this technique, however, has no demonstrable effect on tendon healing or vascularity, manual muscle strength, or clinical rating scales. Whether fibrin matrix is the ideal substrate to enhance tissue healing remains unknown, and perhaps other forms of growth factors may prove to be better at enhancing tissue healing following surgery. [31]

Kissenberth et al observe that the tangent sign is an easily performed and reproducible tool with good intraobserver and interobserver reliability that is a powerful predictor of whether a rotator cuff tear will be repairable. [32]

Deniz et al evaluate the changes in fatty degeneration and atrophy of rotator cuff muscles after arthroscopic repair. The authors found that initial muscle atrophy and fatty degeneration did not improve even after a successful rotator cuff repair where the tendon anatomic integrity was maintained for at least 2 years. [33]

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