Prediction of Rotator Cuff Repair Failure by Histological Analysis

© 2009 The British Elbow & Shoulder Society. Background: We aimed to determine if recognised histological features seen in specimens taken during rotator cuff repair could predict which tendon repairs were at risk of re-rupture. Methods: Forty rotator cuff tendon edge specimens from 40 patients were analysed histologically following routine mini-open rotator cuff repair. Thirty-two patients returned at a mean follow up of 35 months for an ultrasound examination to determine repair integrity. Results: Overall there were 8 small tears, 13 medium tears, 15 large tears and 4 massive tears. Of the 32 patients followed up with ultrasound scan (USS) the overall re-rupture rate was 46%. Small and medium tears had a re-rupture rate of 35% while 60% of the large and massive tears suffered a re-rupture. Comparison of histological features and repair integrity revealed that the rotator cuff repairs which remained intact demonstrated a greater reparative response, in terms of increased fibroblast cellularity, cell proliferation and a thickened synovial membrane, than those repairs that re-ruptured. The larger tears that did remain intact also showed a higher degree of vascularity and a significant inflammatory component than the larger tears that re-ruptured. Conclusion: These results indicate the importance of good tissue quality at the time of surgery but that larger tears can heal if the tissue quality is favourable. Post-operative histological analysis of tendon tear edge can aid prognosis and has the potential to guide post-operative immobilization and subsequent physiotherapy.