Shoulder
The influence of intraoperative factors and postoperative rehabilitation compliance on the integrity of the rotator cuff after arthroscopic repair

https://doi.org/10.1016/j.jse.2014.06.050Get rights and content

Background

The purpose of this study was to determine when cuff re-tear commonly occurs in the postoperative period and to investigate the clinical factors that might predispose to an early cuff re-tear.

Methods

All patients with rotator cuff (supraspinatus ± infraspinatus) tear that required arthroscopic repair during the period between June 1, 2010, and May 31, 2012, with completed serial ultrasound examinations at 6 weeks, 12 weeks, and 26 weeks postoperatively were included. Intraoperative findings were noted. Functional clinical outcomes were assessed by Constant score, Western Ontario Rotator Cuff Index, and Oxford score. Compliance of patients with postoperative rehabilitation was established.

Results

There were 127 cases; the mean age of patients was 60 years. Overall re-tear rate was 29.1%. The percentage of new re-tears was significantly higher in the first 12 weeks than in the second 12 weeks postoperatively (25.2% and 3.9%, respectively). The patient's postoperative compliance was a significant prognostic factor for re-tearing. Significant associations were also found between re-tear and primary tear size, tendon quality, repair tension, cuff retraction, and footprint coverage. Poor compliance of patients was highest (17.3%) during the second 6 weeks postoperatively. Better functional outcomes were noted in patients who had re-torn their cuffs at the 12-week period (Oxford mean scores, P = .04).

Conclusions

Understanding of the predisposing factors will assist in predicting the prognosis of the repaired rotator cuff. Despite the progress of patients' functions postoperatively, an early significant improvement of the clinical outcome should be a warning sign to a surgeon that the patient's compliance may be suboptimal, resulting in an increased risk of the cuff's re-tearing.

Section snippets

Materials and methods

This is a retrospective study of prospectively collected data of patients operated on during the period between June 1, 2010, and May 31, 2012. Details were retrieved from the Socrates Orthopaedic Outcomes Software database (Ortholink Pty Ltd, Pyrmont, NSW, Australia). Inclusion criteria consisted of patients with a chronic rotator cuff tendon tear diagnosed preoperatively by either ultrasound or magnetic resonance imaging and subsequently undergoing arthroscopic cuff repair and patients who

Results

A total number of 125 patients were included in the study. There were 77 men and 48 women with an average age at surgery of 60 ± 9 years (range, 40-83 years). Two patients had bilateral shoulder cuff repair, making the total cases 127. An acromioplasty was performed in 50 shoulders. One shoulder had a tenotomy of the long head of the biceps, and 8 shoulders had biceps tenodesis at the bicipital groove, distal to the rotator cuff repair. There were no cases involving the excision of the outer

Discussion

To our knowledge, this study is the largest series so far reported evaluating rotator cuff healing after an arthroscopic repair performed by a single surgeon, at multiple time points using serial ultrasound investigations. The 6-month follow-up period was used in this study, aiming to evaluate the factors affecting the early healing and structural integrity of the repaired cuff tendon and not the long-term clinical outcomes.21 In vivo animal studies of rotator cuff repairs have shown that

Conclusions

The patient's poor compliance to rehabilitation postoperatively is a significant independent prognostic factor that determines cuff re-tearing after surgery. Other significant factors that may reduce the repaired cuff integrity include a large primary tear size, poor tendon quality, high repair tension, highly retracted cuff, and poor footprint coverage by the repaired tendon. The patient's compliance may be reduced throughout different phases of rehabilitation. Continuous monitoring of the

Acknowledgments

The authors wish to thank Mr Chris Howitt (ultrasonographer), Mrs Teresa Johnson (nurse practitioner), and Miss Clarice Field for their assistance in the data collection as well as Mrs Nurazlina Abdul Rashid (Lecturer in Statistics) for her help in data analysis.

Disclaimer

The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (21)

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This research was approved by the University of Wollongong/Illawarra Shoalhaven Local Health District Health and Medical Human Research Ethics Committee (Reference HE13/241).

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