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. 2019 Mar 11;3(1):12-20.
doi: 10.1016/j.jses.2019.01.002. eCollection 2019 Mar.

Are we getting any better? A study on repair integrity in 1600 consecutive arthroscopic rotator cuff repairs

Alexander H McColl  1 , Patrick H Lam  1 , George A C Murrell  1
Affiliations

Are we getting any better? A study on repair integrity in 1600 consecutive arthroscopic rotator cuff repairs

Alexander H McColl et al. JSES Open Access. .

Abstract

Background: Postoperative retear is the most common surgical complication after rotator cuff repair. This study aimed to determine whether there had been any improvements in rotator cuff repair integrity in our center and to identify any changes in the management of rotator cuff tears that may have impacted postoperative retear rate.

Methods: This retrospective observational single cohort study used running average analysis to examine 1600 consecutive patients over 8 years, who underwent primary arthroscopic rotator cuff repair by a single surgeon, and had cuff integrity assessed by ultrasound 6 months after operation.

Results: Retear rates ranged from 3% to 34%, with a mean of 15%. Over our study retear rates decreased from 18% to 5%. Reductions in retear rates were associated with less aggressive rehabilitation, postoperative abduction sling use, and increased surgical experience. Increases in retear rates were associated with increased false positives with a more sensitive ultrasound machine and learning curves with new equipment for a surgeon and sonographer.

Conclusion: A decrease in retear rate after arthroscopic rotator cuff repair occurred during our study. Although the study design prevents us from directly attributing changes in retear rate to changes in management, our results suggest that rehabilitation optimization and increased surgeon experience decrease postoperative retear.

Keywords: Rotator cuff tear; arthroscopic rotator cuff repair; learning curve; rehabilitation; retear; ultrasound imaging.

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Figures

Figure 1
Figure 1
Proportion of partial thickness repairs by each year of our study.
Figure 2
Figure 2
Overall retear rates moving average by case number (sampling period 100).
Figure 3
Figure 3
Retear rate moving average for tear size area by case number. (A) <200 mm2 (sampling period: 66); (B) 200-600 mm2 (sampling period: 55); (C) ≥600 mm2 (sampling period: 25).
Figure 4
Figure 4
Retear rate moving average for age by case number. (A) Age ≤39 years; (B) age 40-49 years (sampling period: 20); (C) age 50-59 years (sampling period: 46); (D) age 60-69 years (sampling period: 43); (E) age 70-79 years (sampling period: 22); (F) age ≥80 years (sampling period: 5).
Figure 5
Figure 5
Retear rates moving average for tear thickness by case number. (A) Full-thickness tears (sampling period: 81); (B) partial-thickness tears (sampling period: 66).
Figure 6
Figure 6
Retear rates moving average for hospital operation was completed by case number. (A) Private hospital (sampling period: 100); (B) public hospital (sampling period: 13).
Figure 7
Figure 7
Operation time moving average by case number (sampling period: 100).
Figure 8
Figure 8
Overall retear rates moving average by operation date and changes in management of rotator cuff repairs (dates of changes marked on the graph have been adjusted to reflect the sampling period) (sampling period: 100).
See this image and copyright information in PMC

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