title: Revision versus primary arthroscopic rotator cuff repair: a 2-year analysis of outcomes in 360 patients.
abstract: BACKGROUND
  Symptomatic rotator cuff tears are often treated surgically. However, there is a paucity of information regarding the outcomes of revision arthroscopic rotator cuff repairs.
  
  
  OBJECTIVE
  To evaluate the outcome of revision arthroscopic rotator cuff surgery when compared with primary arthroscopic rotator cuff surgery in a large cohort of patients.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  A consecutive series of 50 revision arthroscopic rotator cuff repairs performed by a single surgeon, with minimum 2-year follow-up, were retrospectively reviewed using prospectively collected data. As a comparison, 3 primary arthroscopic rotator cuff repair cases (primary group; n = 310) were chosen immediately before each revision case, and 3 were chosen after. Standardized patient-ranked outcomes, examiner-determined assessments, and ultrasound-determined rotator cuff integrity were assessed preoperatively at 6 months and at a minimum of 2 years after surgery.
  
  
  RESULTS
  The revision group was older (mean age, 63 years; range, 43-80 years) compared with the primary group (mean age, 60 years; range, 18-88 years) (P < .05) and had larger tear size (mean ± SEM) (4.1 ± 0.5 cm(2)) compared with the primary group (3.0 ± 0.2 cm(2)) (P < .05). Two years after surgery, the primary group reported less pain at rest (P < .02), during sleep (P < .05), and with overhead activity (P < .01) compared with the revision group. The primary group had better passive forward flexion (+13°; P < .05), abduction (+18°; P < .01), internal rotation (+2 vertebral levels; P < .001) and also significantly greater supraspinatus strength (+15 N; P < .001), lift-off strength (+9.3 N; P < .05), and adduction strength (+20 N; P < .01) compared with the revision group at 2 years. When compared with the primary group, the revision group was more satisfied with the overall shoulder function before surgery but was less satisfied with their shoulder function than the primary group at 2 years (P < .005). The retear rate for primary rotator cuff repair was 16% at 6 months and 21% at 2 years, while the retear rate for revision rotator cuff repair was 28% at 6 months and deteriorated to 40% at 2 years (P < .05).
  
  
  CONCLUSIONS
  The short-term clinical outcomes of patients undergoing revision rotator cuff repair were similar to those after primary rotator cuff repair. However, these results did not persist, and by 2 years patients who had revision rotator cuff repair were twice as likely to have retorn compared with those undergoing primary repair. The increase in retear rate in the revision group at 2 years was associated with increased pain, impaired overhead function, less passive motion, weaker strength, and less overall satisfaction with shoulder function.
authors.affiliation: Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Aminudin
authors.initials: A
authors.lastname: Shamsudin
authors.affiliation: Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Lam
authors.affiliation: Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Karin
authors.initials: K
authors.lastname: Peters
authors.affiliation: Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Imants
authors.initials: I
authors.lastname: Rubenis
authors.affiliation: Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hackett
authors.affiliation: Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia murrell.g@ori.org.au.
authors.forename: George A C
authors.initials: GA
authors.lastname: Murrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012399:Rotation; D017006:Rotator Cuff / Q000473:pathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000150:complications / Q000473:pathology / Q000601:surgery; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
keywords: arthroscopic rotator cuff repair; outcomes; revision surgery; rotator cuff