Jae Chul Yoo - Revision for shoulder rotator cuff surgery pusm_肩关节培训班.pptxVIP

Revision Rotator Cuff Tear: Why? And How? Jae Chul Yoo MD, Jin Ho Hong MD 유재철, 홍진호 Department of Orthopedic Surgery, Sungkyunkwan University College of Medicine, Samsung Medical Center, SEOUL, KOREA Thank you • Main cause…? • No retear but stiffness • Missed Dx Subscapularis tear… • Biceps tear/Adhesion? • TA or Work comp • Probably M/C Cause … • Retear? • Adhesion? • Missed problems? Or Wrong indication? • New problems? • Secondary gain? • Combined or all… Why Do We Fail Our RC Repair? Topics • Why do they fail? • When do we decide to re-repair? • What are results? • What are the key to success? • Cases… Why Do They Fail? Retear after Repair… • Something we all do not want… • But we all do have… • Probably most common cause of failure… Retear of Supraspinatus • Overall retear rates of index surgery – 13% ( 14 of 108 pts.) ~ (Bellumore, 2006, JBJS) 94% ( 17 of 18 pts.) (Galatz, 2004, JBJS) RC Retear Factors… • Many – The factors affecting tendon healing • Patient’s age, • The size and extent of the tear, • Presence of fatty degeneration • Repair technique? • Postoperative rehab? • Etcs.(Smoking, DM, RA, over tensioning, insufficient subacromial decompression) • … Cho Rhee 2011 AJSM The healing rate lowers by increase of number of tendons involved. (single tendon:two tendon:three tendon = 80:57:32,%) Why Do They Fail? JBJS Am 1991 Retear rates after rotator cuff repair doubles when the preoperative tear size increase by 1cm. Why Do They Fail? JSES 2009 Retear Tear Size • Size • Retear Our Results • Type I, II R Single row repair Double row (TOE) p-value Total patient (n=415) 190 225 Age (mean) 58.99 ± 9.13 59.76 ± 8.18 0.4006 Gender M:F 87 : 103 101 : 124 0.8543 Site Right 131 167 0.2341 Left 59 58 Hand dominance Dominant 135 163 0.8543 Non dominant 51 56 Bilateral 4 6 Smoking 19 20 0.6991 Mean f/u period (month) 53.2 ± 20.72 31.9 ± 11.36 Demographics Repair Type Single row (n=190) Double row (