From the Research
The optimal amount of retraction of the rotator cuff for repair is less than 3 cm, as tears with retraction greater than 3 cm may require advanced techniques such as margin convergence, partial repair, or tendon transfers, and may have a higher risk of repair failure, as shown in a study published in 2016 1.
Key Considerations
- The severity of the tear and tissue quality play a crucial role in determining the optimal amount of retraction for repair.
- Tears with retraction less than 1-2 cm have excellent repair outcomes, while moderate retraction (2-4 cm) can still be repaired with good results.
- Severe retraction (>4-5 cm) presents significant challenges and may require advanced techniques.
- The surgeon must evaluate tissue mobility, quality, and muscle atrophy when determining repairability.
Evidence-Based Recommendations
- A study published in 2010 found that the length of the torn tendon edge was always longer than the length of the avulsed humeral insertion site, and the repair ratio was 2.6 +/- 0.4 (range 2.1-3.5) 2.
- Another study published in 2016 found that repair tension was a significant factor in determining the anatomic outcome of rotator cuff repair, and that high-tension repairs were less likely to result in complete healing 1.
- A study published in 2012 found that musculotendinous retraction in chronic rotator cuff tears results mainly from shortening of the muscle fibers, but in advanced stages, it also results from shortening of the tendon tissue itself 3.
- A study published in 2013 found that the results of the repair of acute rotator cuff tears were not influenced by tear retraction, and that equal patient satisfaction, pain scores, range of motion, strength, and outcome measures should be expected with surgical repair despite the level of retraction 4.
Clinical Implications
- Pre-operative imaging, particularly MRI, helps assess the degree of retraction and tissue quality.
- During surgery, the surgeon will mobilize the tendon by releasing adhesions and scar tissue to reduce tension on the repair.
- Excessive tension due to severe retraction increases the risk of repair failure, so achieving adequate mobilization is crucial for successful outcomes.
- The ultimate goal is to restore the rotator cuff's normal anatomy while minimizing tension on the repair.