Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 13;8(10):2325967120954341.
doi: 10.1177/2325967120954341. eCollection 2020 Oct.

Duration of Surgery and Learning Curve Affect Rotator Cuff Repair Retear Rates: A Post Hoc Analysis of 1600 Cases

Ashleigh R Elkins  1 , Patrick H Lam  1 , George A C Murrell  1
Affiliations

Duration of Surgery and Learning Curve Affect Rotator Cuff Repair Retear Rates: A Post Hoc Analysis of 1600 Cases

Ashleigh R Elkins et al. Orthop J Sports Med. .

Abstract

Background: Arthroscopic rotator cuff repair can be quite complex and time consuming, particularly early in the surgeon's learning curve.

Hypothesis: Patients who have undergone rotator cuff repair with shorter operative times will be less likely to have a rotator cuff retear at 6 months postoperatively.

Study design: Case-control study; Level of evidence, 3.

Methods: This study was an analysis of data from 1600 consecutive patients (670 partial-thickness and 930 full-thickness tears) who had rotator cuff repair performed by a single surgeon utilizing an arthroscopic, single-row, knotless inverted mattress suture anchor technique. All patients underwent ultrasound at 6 months postoperatively to determine repair integrity. Moving average analysis was performed for the variables of operative time and case number to evaluate the surgeon's learning curve.

Results: For early cases, the mean operative time was approximately 35 minutes. After approximately 450 cases, the operative time plateaued at approximately 20 minutes. The mean operative time for the cohort (±SEM) was 22 ± 0.3 minutes, and the mean retear rate was 13%. Increased operative time was associated with a retear (r = 0.18; P < .001). Multiple logistic regression analysis revealed that the variables with the most independent effect on retears were larger tear size (Wald statistic = 36; P < .001), lower case number (ie, less surgeon experience) (Wald statistic = 28; P < .001), older patient age (Wald statistic = 23; P < .001), full-thickness tears (Wald statistic = 13; P < .001), and lower surgeon-rated repair quality (Wald statistic = 8; P = .004). Operative time was not a significant independent factor contributing to retears.

Conclusion: Operative time and rotator cuff retear rates decreased as surgical team experience increased. The hypothesis of this study, however, was not supported. The reduced retear rate was not related to a reduction in operative time per se but rather to improved surgical team experience and patient factors, such as improved healing with smaller tears in younger patients.

Keywords: diagnostic ultrasound; general sports trauma; imaging; rotator cuff; shoulder.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: G.A.C.M. has received research support and consulting fees from Smith & Nephew and has stock/stock options in Kogarah Private Hospital. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Percentage of patients with intact and retorn rotator cuffs at 6 months postoperatively for each of the tear size categories.
Figure 2.
Figure 2.
Mean operative time for each of the tear size categories. Error bars indicate SEMs.
Figure 3.
Figure 3.
Moving average graph for operative time and rotator cuff retears (%), with an increment of 160 patients in a total of 1600 patients.
Figure 4.
Figure 4.
Moving average analysis for operative time and case number, with an increment of 160 patients in a total of 1600 patients.
Figure 5.
Figure 5.
Moving average for case number and retears, with an increment of 160 patients in a total of 1600 patients.
See this image and copyright information in PMC

References

    1. Ahmad S, Haber M, Bokor DJ. The influence of intraoperative factors and postoperative rehabilitation compliance on the integrity of the rotator cuff after arthroscopic repair. J Shoulder Elbow Surg. 2015;24(2):229–235. - PubMed
    1. Ahmadi S, Lawrence TM, Sahota S, et al. The incidence and risk factors for blood transfusion in revision shoulder arthroplasty: our institution’s experience and review of the literature. J Shoulder Elbow Surg. 2014;23(1):43–48. - PubMed
    1. Anthony CA, Westermann RW, Gao Y, Pugely AJ, Wolf BR, Hettrich CM. What are risk factors for 30-day morbidity and transfusion in total shoulder arthroplasty? A review of 1922 cases. Clin Orthop Relat Res. 2015;473(6):2099–2105. - PMC - PubMed
    1. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87(6):1229–1240. - PubMed
    1. Briggs L, Murrell GAC. Diagnostic ultrasound examination of the shoulder. Tech Shoulder Elbow Surg. 2011;12(4):101–107.

LinkOut - more resources