Complex Rotator Cuff Repair with Graft Augmentation Surgery

Overview

Dr. Rashid performs complex and revision (re-do) rotator cuff repair surgery using advanced arthroscopic (keyhole) surgery techniques. It is a safe and effective procedure aimed at repairing the torn tendon(s) to the ball of the shoulder. This procedure can take between 2 and 3 hours, and is often successful at relieving pain, improving movement of the shoulder, and regaining strength with activities. It is performed under general anaesthesia, often with a nerve block (regional anaesthesia) as an adjunct to provide pain relief in the post-surgery period.

In order to improve the chances of a successful outcome, Dr. Rashid utilises two different “graft” types. If your own tendon can reach the bone it is supposed to be attached to, then Dr. Rashid may augment the repair with an absorbable collagen patch. If however, your tendon is missing, then Dr. Rashid may replace your missing tendon with a skin graft, taken from a donor, where all the donor material is removed.

Indications for Surgery

Dr. Rashid will evaluate a large number of factors to determine whether augmentation of your repair is needed. This is largely driven by research he performed during his PhD at the University of Oxford, which showed that some repairs require assistance to achieve successful healing. If your tear is larger, with poor quality tendon tissue, then Dr. Rashid may discuss two different augmentation patches to support your healing tendon.

Pre-Surgery Tests and Assessment

Before any rotator cuff repair surgery, a variety of assessments and tests, such as X-rays, and a MRI scan are performed to assess the size of the tear, which tendons are involved, how far the tendons have moved away from their attachment, and the quality of the muscles in the shoulder. If these factors suggest that healing may be a challenge, then an augment patch may be utilised.

Procedure Details

After sterilising the skin with cleaning solution, a keyhole camera is inserted into the shoulder. After confirming the extent of the tear, Dr. Rashid will then repair the tendons using suture anchors. These are devices inserted into the bone with ultrastrong sutures embedded in them. These sutures are passed through the tendon edge and tied down. Anywhere from 1 to 8 suture anchors may be required, depending on the type and size of cuff you may have. If the quality of the tendon is poor, or the tear is large, an absorbable patch made from collagen taken from bovine tendon is used. This patch stimulates healing and then disappears after approximately 6 months.

Occasionally, there is missing tendon, and Dr. Rashid may utilise a skin graft (taken from a donor) to replace your lost tendon. This is a more complex surgery that may require up to 18 months to regain full function.

Risks and Complications

The risks of rotator cuff repair surgery are not common. These include stiffness (most common risk), infection, and nerve injury (very rare). If the repair needed to be augmented, then non-healing is always a risk in this more challenging repairs.

Recovery and Rehabilitation

Initial recovery is similar to standard rotator cuff repair surgery however the rehabilitation is intentionally slower to allow the graft to heal and to minimise stressing the repair too soon. Dr. Rashid will put together a personalised protocol with your physiotherapist to ensure appropriate rehabilitation is done in the correct manner.

Expected Outcomes

The majority of people having this surgery are satisfied with the outcome. Pain relief, return to better quality sleep, and improved movement are the norm after this surgery. If the tendon needs to be replaced with a skin graft, the outcomes of this technique are not as robust as a standard rotator cuff repair without any augmentation. This is mainly due to challenges in achieving healing of the graft and difficulties in regaining overhead strength in some patients.