Rotator cuff and capsule healing after shoulder arthroscopy: A second look arthroscopic study.

Background: Shoulder arthroscopy is commonly used for the repair of glenohumeral ligament avulsions or tendon tears. The success of the operation depends on the ability of the ligaments or rotator cuff tendon to heal to their original attachment site. Soft tissue healing can be evaluated with imaging methods or alternatively with second-look arthroscopy.

Aim: To investigate shoulder tendon and capsule healing after arthroscopic rotator cuff and instability repair using second-look arthroscopy.

Methods: In this study, 24 adult patients with rotator cuff tears (13 patients) or anterior shoulder instability (11 patients) were included. All patients were initially subjected to arthroscopic repair using suture anchors and were re-evaluated with second-look arthroscopy for reasons not related to the original pathology. The second operation was performed in 8 patients due to mild but persistent pain or stiffness, in 3 patients for recalcitrant stiffness, in 5 patients for secondary biceps tenotomy, in 6 patients for persistent acromioclavicular joint pain and in 2 patients for suture anchor prominence causing shoulder grinding. Soft tissue healing was evaluated visually and by probing, whereas clinical outcomes were evaluated using the University of California-Los Angeles (UCLA) and Rowe rating scales.

Results: In almost all patients, complete soft tissue healing occurred at the site of tissue reattachment, either on the glenoid articular surface or the greater humeral tuberosity. The strongest repair, as confirmed by probe palpation, was encountered at the site of suture passage through the soft tissue. All suture material was covered with bursal synovial tissue, with no cases of knot impingement or cartilage fraying. The mean preoperative and postoperative UCLA scores for rotator cuff repair patients were 1354 ± 3205 and 2931 ± 2898, respectively (P < 0.001), whereas for shoulder instability patients, the mean Rowe scores preoperatively and postoperatively were 2591 ± 1338 and 9272 ± 754, respectively (P < 0.001). The use of bioabsorbable implants did not cause synovitis or other tissue reactions.

Conclusion: Soft tissue healing in the shoulder is successful and strongest at the site of suture anchor placement.