Rotator Cuff Tears: When Is Rotator Cuff Augmentation Needed?

Rotator Cuff Tears: When is Rotator Cuff Augmentation Needed?

The rotator cuff muscles surround and stabilize the shoulder joint. Rotator cuff tears result when the tendons of these muscles are torn from the upper arm bone. If surgery is recommended and the patient decides to proceed, the surgeon considers many surgical options for the patient. If repair is chosen, the surgeon's goal is to maximize the patient's chances of a completely healed rotator cuff repair.

When is biologic augmentation needed? The surgeon will evaluate the patient's rotator cuff in 6 areas to predict how it will heal on its own to determine if augmentation is needed. Advanced age is associated with a reduced blood supply and slower cellular recovery, both of which are essential for surgical healing. Additionally, older patients may be affected by certain health conditions, such as diabetes or heart disease, that can slow the healing process. Patients over 70 years of age have twice the risk of a rotator cuff retear after surgery.

Tear size refers to the width of the tendon detachment from the bone. Larger tears often involve multiple tendons and create a greater area of stress, which may weaken the repair during recovery. Tears greater than 2.5cm reduce the likelihood of complete healing. Tear retraction describes how far the tendon has pulled away from its normal position on the bone. When a tear has been present for a long time, the muscle becomes short and stiff. This makes it difficult for the tendon to reach its normal attachment on the upper arm bone. Retraction beyond three centimeters increases the risk of a retear by nearly 10 fold.

When a tendon remains torn for an extended period, the muscle becomes inactive. Over time, these inactive muscle cells are replaced by fat cells in a process known as fatty infiltration. Weakening the muscle cells reduces the healing ability and strength of the repair. Fatty infiltration can triple the risk of a retear. Rotator cuff repairs rely on anchors placed in the bone. Bone quality affects how securely the repair can be fixed. Conditions like osteoporosis weaken bone, making it harder for anchors to stay in place and support healing during recovery.

Lastly, high physical demands after surgery, such as heavy manual labor or athletic strain place additional stress on the repair. Patients with high activity levels have approximately twice the risk of incomplete healing. To summarize, the surgeon can evaluate these 6 factors to estimate the probability of tendon healing. If the surgeon determines that the chance of healing is too low, a biologic augmentation may be recommended. This involves adding a tissue graft to reinforce the repair and improve healing outcomes.