Clinical and biomechanical performance of patients with failed rotator cuff repair.

Purpose: The purpose of the study was clinical and advanced biomechanical evaluation of shoulder function with respect to rotator cuff (RC) integrity following repair.

Methods: This was a retrospective study of 111 cases with solid single row rotator cuff repair and a minimal one-year follow-up. The RC repair was performed as an open procedure in 42 patients, arthroscopically assisted in 34 and fully arthroscopic in 48 cases. Evaluation protocol included ultrasound evaluation of the RC integrity, clinical evaluation using shoulder scores and advanced biomechanical evaluation (isometric and the isokinetic strength testing).

Results: Ultrasound evaluation revealed complete retear in 16%, partial retear in 10% and intact repair in 74% of the cases. Isometric testing of flexion and abduction had shown that shoulders with complete retear were weaker by 45% compared to those with full tendon healing. Isokinetic testing revealed 29-43% deficits in peak external rotation torque comparing complete retear vs. normal healing. Patients' ability to generate shoulder power and withstand a load proved to be lower in circumstances of a complete lack of healing (40-43% and 34-55%, respectively). Partial retears did not have a negative impact on the biomechanical properties of shoulders. Surprisingly, there were no significant differences in the shoulder scores related to the quality of healing. In terms of patient satisfaction the results were good and the patients declared themselves better in all cases, no matter what quality of healing had been recorded ultimately.

Conclusions: According to the results of this research rotator cuff integrity after open or arthroscopic repair does not seem to affect clinical scores. Recurrent tears may result in lower muscle performance in terms of active motion, strength and endurance. Advanced shoulder testing may be essential in assessing the patients' ability to return to sports or heavy labour.