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

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 Why Do We Fail Our RC Repair? • Retear? • Main cause…? • Adhesion? • No retear but stiffness • Missed problems? • Missed Dx Or Wrong indication? Subscapularis tear… • New problems? • Biceps tear/Adhesion? • Secondary gain? • TA or Work comp • Combined or all… • Probably M/C Cause … 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 Why Do They Fail? JBJS Am 1991 The healing rate lowers by increase of number of tendons involved. (single tendon:two tendon:three tendon = 80:5