Sterile synovio-cutaneous fistula: A potential complication of repair of large and massive rotator cuff tears

We present 4 patients who underwent mobilization and repair of large or massive rotator cuff tears (maximum dimension, ≥3.0 cm). In all 4 patients, sterile synovio-cutaneous fistulas developed within several weeks of the index procedure. All required further debridement surgery, multiply in 3 cases, with 1 case requiring a rotational flap for wound closure. Tissue at surgery appeared necrotic and avascular, with extensive inflammatory response, and we postulate that this was possibly related to the extensive mobilization needed to achieve cuff closure. Despite the complications, all fistulas eventually were closed, and all 4 patients were eventually satisfied with the functional status of their shoulders. We conclude that a sterile synovio-cutaneous fistula is a possible complication of mobilization and repair of large or massive rotator cuff tears.