The irreparable rotator cuff presents a challenging problem to shoulder surgeons worldwide; there is often no clear consensus on which treatment is best. Therefore, it is important to carefully assess every case and tailor treatment options to the unique demands of each patient. If surgery is carried out sooner it may still be possible to achieve a primary tendon repair. However, with delays to surgery or in revision cases (tendon re-tear) the options may be limited and/or more complex.
The rehabilitation after surgery for an irreparable rotator cuff (and/or revision cases) is longer and the outcome may not be as reliable as with early primary repair. Improvements in biological augmentation and stem cell therapy are providing new options and hope for patients.
Rotator cuff tendon tears may be so extensive that they cannot be repaired back to their original anchor point (insertion) on the humeral head. This may happen in a number of situations:
Irreparable rotator cuff tears will result in loss of function and/or pain.
Eventually an irreparable tendon tear will lead to shoulder joint arthritis – often referred to as rotator cuff arthritis (arthropathy).
This depends on a number of factors, such as:
The main surgical options currently are:
There are three essential components to a good outcome from surgery
Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery.
The JPL pathway allows for self-directed, early passive shoulder range of movement:
A sling will be required for at least 6 weeks after surgery. Depending on your procedure, you may require a sling for longer.
Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications.
Specific risks relating surgery for an irreparable rotator cuff:
Patients who smoke, use tobacco products, have diabetes, or elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound healing.
The surgical outcomes for an irreparable rotator cuff tear depend on many factors
Depending on the choice of surgery the rehabilitation may be extensive. However, patients report an improvement in function and reduction in pain after surgery.
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