You had surgery to repair your rotator cuff tear. Your recovery was not as rapid or complete as you would have liked. In an effort to see why your shoulder is still bothering you your doctor orders a new MRI. You are very surprised when the MRI shows a new tear of your rotator cuff. Why didn’t your rotator cuff heal?
Rotator cuff tears are very common. The research shows that many of us over 50 have rotator cuff tears and do not even know it. Most people with rotator cuff tears did not injure themselves. They woke up one day and their shoulder pain was intense.
Rotator cuff tears tend to hurt us at night. That night pain can be quite disturbing. Rotator cuff tears also cause pain with certain motions or with lifting everyday objects like a gallon of milk.
Not all rotator cuff tears will require surgery. Small “degenerative” tears are usually managed with physical therapy and injections. If there is no response to PT and your quality of life is poor you may have been offered rotator cuff repair surgery.
During the surgery to repair a worn out and torn rotator cuff we clean out the inflamed tissue that was bothering you, and we clean up the frayed edges of your rotator cuff. We place sutures into the bone and the rotator cuff. When we tie those stitches the rotator cuff is reattached to the bone. What could go wrong? Why doesn’t the rotator cuff always heal?
After the rotator cuff is attached to the bone it will require a lot of time to heal. Sometimes the reason why the rotator cuff doesn’t heal and tears again is that you may have become too active too quickly. This is a less common reason for failure of rotator cuff surgery. This post discussed 4 key principles to understand about rotator cuff healing to improve your chances of success.
As I have spoken about many times on this website, most rotator cuff tears are due to degeneration or wearing out of your rotator cuff. That means that your tendon is physically changing as we age. Therefore, in essence, when we perform a rotator cuff repair surgery we are trying to repair degenerative tissue. If the rotator cuff tendon remains thick and strong then there is a higher chance that the tear will heal.
For the longest time Orthopedic Surgeons have looked at healing of rotator cuff tears as a mechanical issue. For example… we designed stronger sutures and stronger ways to keep the sutures in the bone. It’s only been over the last few years that we realized that this is mostly a biological problem. For example… it doesn’t matter how strong your stitches are if the stuff that you are sewing is frayed and falling apart. Imagine sewing that hole in the front of your bluejeans? Imagine sewing a hole in the heel of your sock? That’s not going to work well. This is another reason why many rotator cuff repairs fail.
Most rotator cuff surgery failures are due to the fact that the rotator cuff tissue is degenerative and was not capable of holding the sutures long enough to allow for healing to take place. In addition… it appears that most people with degenerative rotator cuff tears do not have many important healing cells in their shoulder.
The future of rotator cuff repairs will now start to focus on biology. We need to figure out how to transform the rotator cuff into a thick healthy tissue that is capable of holding sutures and healing. In addition, we know that cells needed for healing are found in lower concentrations around chronic rotator cuff tears. We need to find ways to stimulate those cells to populate and thrive in the are of the rotator cuff that we repaired.
We can’t ignore biology… and once we figure this out, we will be able to decrease the number of failed or recurrent rotator cuff tears.