title: The long-term outcome of recurrent defects after rotator cuff repair.
abstract: BACKGROUND
  Retears of the rotator cuff are not uncommon after arthroscopic and mini-open rotator cuff repairs. In most studies, the clinical results in patients with persistent defects demonstrated significantly less pain and better function and strength compared with their preoperative state at an early follow-up.
  
  
  OBJECTIVE
  The clinical and structural outcomes of patients with known rotator cuff defects will remain unchanged after a longer period of follow-up.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  This study was performed in 15 patients (18 shoulders) from a previous study who had recurrent rotator cuff defects 3.2 years after repair. Each patient completed the American Shoulder and Elbow Surgeons Scoring Survey, the Simple Shoulder Test, the L'Insalata Scoring Survey, and a visual analog scale for pain. Eleven patients (13 shoulders) were clinically reexamined at an average of 7.9 years for range of motion and strength, with targeted ultrasound.
  
  
  RESULTS
  At the 7.9 year follow-up the average scores were 95 (American Shoulder and Elbow Surgeons), 95 (L'Insalata), 11 (Simple Shoulder Test), and 0 (visual analog for pain), which were not statistically significantly different from the scores at 3.2 years. There was no change in the average range of motion; however, there was a statistically significant reduction in forward flexion strength and external rotation strength, as measured by a dynamometer. The average external rotation strength decreased by a mean of 42% and the mean forward flexion strength decreased by a mean of 45% (P < .001). Furthermore, there was a statistically significant increase in the mean size of the defect, from 273 mm(2) to 467 mm(2) (P < .001). Finally, the size of the defect increased in all patients, and no defects healed structurally.
  
  
  CONCLUSIONS
  At an average of 7.9 years, patients with recurrent defects after rotator cuff repair still had an improvement in terms of pain, function, and satisfaction. However, the rotator cuff defect significantly increased in size, and there was a progression of strength deficits. These findings suggest that patients with recurrent defects can remain asymptomatic over the long term but will predictably lose strength in the involved extremity. Furthermore, the study demonstrated that defects after rotator cuff repair increase in size but often remain asymptomatic.
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 10021, USA. dodsonc@hss.edu
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Dodson
authors.forename: Alison
authors.initials: A
authors.lastname: Kitay
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Adler
authors.forename: Joseph
authors.initials: J
authors.lastname: Nguyen
authors.forename: Frank A
authors.initials: FA
authors.lastname: Cordasco
authors.forename: David W
authors.initials: DW
authors.lastname: Altchek
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012008:Recurrence; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D011795:Surveys and Questionnaires; D013997:Time Factors; D017211:Treatment Failure; D014463:Ultrasonography