Dr Aubrey Smith, Orthopedic Surgery
Shoulder Surgery, Arthroscopic and Reconstructive Surgery
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Dr Aubrey Smith, Orthopedic Surgery
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Shoulder News As always, this is educational and not a substitute for a medical opinion that you get from going to the doctor. Click here to see some arthroscopic pictures
All Arthroscopic Rotator Cuff Surgery Many shoulder surgeons across the country are interested in performing the classic rotator cuff repair through the arthroscope. All arthroscopic surgery is popular because it makes for a smaller scar and patients tend to believe that it is less uncomfortable post operatively. While this is great news, the rehabilitation is usually about the same. The tendons that are torn loose from the bone must be sewn back into place and allowed to heal. We have currently performed several hundred of the all arthroscopic procedures and the data that we have collected on our patients suggests that the results are similar to the open procedure. We studied on two different occasions more than a hundred consecutive patients undergoing open rotator cuff repair available for follow up at at least one year post operatively and have noted good or excellent results in 94% of cases. These results are excellent and suggest that if all arthroscopic surgery is to be useful, the results need to be as good as with the classic procedure. Our early data and data from other surgeons across the country suggests that this is likely. Who is a candidate for all arthroscopic surgery? Many people that have a repairable tear can undergo the all arthroscopic procedure. I still believe that giant tears that need special attention need to be fixed open, but a good majority of tears can be repaired arthroscopically. In a classic article by the very famous Dr. Bigliani group in New York published recently in the Journal of Bone and Joint Surgery, the redo or revision of rotator cuff tears was studied. Rotator Cuff Tear Revision Surgery The article is on page 1849 of the December 2001 Journal of Bone and Joint Surgery and to get the actual article, you will probably have to go to the library of medicine. Rotator cuff tears are very common in the average population. The four muscles that hold the "ball" on the "socket" of the shoulder are called collectively the Rotator Cuff muscles. Rupture of one or more of these tendons is a "rotator cuff tear". The repair of the rotator cuff has been the focus of intensive study since the famous E A Codman did the first repair in 1934. Unfortunately, it wasn't until Dr. Neer, in the 70's, decided that removal of the "spur" or the prominence of bone that overlies the top tendon, the supraspinatus, was crucial to the success of the surgery. Many studies have been done since the original classics. Nowadays, it is common for some surgeons to even fix or repair the rotator cuff all arthroscopically. Results from surgery vary. Good or excellent results are common. In fact, most studies give the suggestion that after a repair, 90% good or excellent results are achieved. This is encouraging news. However, what happens when a repair doesn't work? Why? What was the problem? The answer is too complex to answer completely here. Very big tears that have been present a really long time or are associated with older age groups, people in poor health, people that smoke a lot, or patients that don't follow the rigorous post op regimens are just a few of the causes of a tear that simply didn't heal. No one can fix every tear perfectly. Ask your surgeon about his results to get an idea about the odds of successful surgery. Why is Dr. Bigliani's article a big deal? This study puts into perspective the idea that redo or revision rotator cuff surgery is a challenge for any surgeon. It points out that the results may not be as good as in first time surgery. In this study, 69% of the patients had a satisfactory result and 31% had less than satisfactory results. Pain relief was achieved in most of the patients, however. In conclusion, pain relief was good in most patients even if full function (the less than satisfactory group) was not achieved. Why is this important? Early diagnosis of shoulder problems by an Orthopaedic Surgeon often times leads to a treatment plan that has a good chance of treating the problem with success. Delay in treatment can make the first surgery harder. If you have a shoulder problem, don't ignore it. Seek out the diagnosis so you can make a good choice about what is right for you. See an Orthopaedic Surgeon. If you do have a repair that hasn't healed, then Dr. Bigliani's paper should give you some hope that even if it is harder surgery, pain relief can be achieved in many cases and it is often not a hopeless situation. Redo surgery isn't for everyone. Only you and your Orthopaedic Surgeon can make that choice. If you want to learn more about the rotator cuff, click on my website at the academy found below. Click on "patient info/forms" and then scroll down to "rotator cuff tears". Be patient if you are not high speed, the list is extensive. http://OrthoDoc.aaos.org/DrAubreySmith
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Last modified08/23/09: |
