Our Summary

The aim of a particular type of shoulder surgery (massive, retracted rotator cuff repair surgery) is to aid healing, reduce pain and restore strength. However, this is often difficult to achieve in patients who have large, chronic tears in the rotator cuff that are pulled back (retracted) from their original position and have undergone fatty degeneration. Previous research has shown that if the tension on the repair site is too high, the surgery is more likely to fail.

One way to reduce this tension is to use a surgical technique called arthroscopic mobilization and muscle advancement (AMA). In this procedure, the areas of the shoulder muscles that are attached to the shoulder blade are loosened and moved forward towards the repair site. After this, the tendons are repaired using a linked double-row technique. This approach has been found to improve the success rate of these high-risk shoulder surgeries.

Therefore, surgeons should consider using the AMA technique in cases where traditional surgical techniques fail to achieve a low-tension state, which can lead to a higher success rate for the surgery.

FAQs

  1. What is the goal of massive, retracted rotator cuff repair surgery?
  2. How can repair tension be decreased in rotator cuff repair surgery?
  3. What is the benefit of using arthroscopic mobilization and muscle advancement (AMA) in rotator cuff repair surgeries?

Doctor’s Tip

One helpful tip a doctor might give a patient about rotator cuff repair is to follow a proper rehabilitation protocol after surgery. This typically includes physical therapy to help regain strength, range of motion, and function in the shoulder. It is important to follow the recommendations of your physical therapist and surgeon to ensure the best possible outcome and avoid complications.

Suitable For

Patients who are typically recommended for rotator cuff repair surgery include those with large, retracted, chronic, and fatty degenerated tears that have not responded to conservative treatment measures such as physical therapy or corticosteroid injections. These patients may experience significant pain, weakness, and loss of function in the affected shoulder. High repair tension is a risk factor for failed repairs, so patients with this issue may benefit from arthroscopic mobilization and muscle advancement (AMA) techniques to decrease tension and improve outcomes. Surgeons should consider adding AMA to their surgical approach for patients with high-risk rotator cuff tears that have not responded to traditional repair techniques.

Timeline

  • Initial consultation: Patient presents with shoulder pain and limited range of motion, and is diagnosed with a rotator cuff tear.
  • Pre-operative preparation: Patient undergoes imaging tests such as MRI to determine the extent of the tear and meets with the surgeon to discuss treatment options.
  • Rotator cuff repair surgery: Surgeon performs arthroscopic mobilization and muscle advancement (AMA) of the supraspinatus and infraspinatus muscle bellies, followed by a linked double-row repair of the tendons.
  • Post-operative recovery: Patient undergoes physical therapy to regain strength and range of motion in the shoulder. Healing process begins, with the goal of structural healing for pain relief and strength restoration.
  • Follow-up appointments: Patient continues to see the surgeon for follow-up appointments to monitor progress and adjust the rehabilitation plan as needed.
  • Long-term outcome: Patient experiences improved shoulder function and reduced pain as the rotator cuff repair heals and strengthens over time.

What to Ask Your Doctor

  1. What is the success rate of rotator cuff repair surgery for my specific type of tear?
  2. What are the potential risks and complications associated with the surgery?
  3. How long is the recovery time and what can I expect during the rehabilitation process?
  4. Will I need physical therapy after the surgery and for how long?
  5. Are there any alternative treatment options to surgery that I should consider?
  6. How soon after surgery can I expect to regain full range of motion and strength in my shoulder?
  7. What type of activity restrictions will I have after surgery and for how long?
  8. What are the long-term outcomes for patients who undergo rotator cuff repair surgery?
  9. How often will I need follow-up appointments to monitor my progress?
  10. Are there any specific factors about my tear or shoulder condition that may affect the success of the surgery?

Reference

Authors: Hartzler RU. Journal: Arthroscopy. 2024 Dec;40(12):2812-2814. doi: 10.1016/j.arthro.2024.07.014. Epub 2024 Jul 20. PMID: 39038501