Retear rate in the late postoperative period after arthroscopic rotator cuff repair

Am J Sports Med. 2014 Nov;42(11):2606-13. doi: 10.1177/0363546514547177. Epub 2014 Sep 3.

Abstract

Background: Few clinical studies have evaluated the integrity of repaired tendons and identified the timing of retears through the use of serial imaging.

Hypothesis: Retears after arthroscopic rotator cuff repair are uncommon in the late postoperative period (after 3 months).

Study design: Case series; Level of evidence, 4.

Methods: Among 221 arthroscopic rotator cuff repairs that were performed at a single hospital between May 2010 and February 2012, 61 were involved in this study. Rotator cuff tears consisted of 12 small, 31 medium, 8 large, and 6 massive rotator cuff tears. Additionally, 4 isolated subscapularis tears were included. For clinical evaluation, all patients were assessed both preoperatively and postoperatively by use of the University of California-Los Angeles Shoulder Rating Scale, absolute and relative Constant scores, and American Shoulder and Elbow Surgeons score; active range of motion was assessed as well. For radiological evaluation, all 61 patients had a magnetic resonance imaging (MRI) evaluation at 3 months postoperatively. Among them, 23 patients were evaluated for repaired tendon integrity on postoperative MRI at a minimum of 1 year after surgery (mean, 14.1 months; range, 12-19 months), and results were classified according to the Sugaya classification: type I, sufficient thickness with homogeneously low intensity on each image; type II, sufficient thickness, partial high-intensity area; type III, less than half the thickness without discontinuity; type IV, minor discontinuity; and type V, major discontinuity. The remaining 38 patients, who refused to undergo MRI again for financial reasons, were evaluated through ultrasound.

Results: Statistically significant clinical improvements were observed after surgery. The MRI conducted at 3 months postoperatively identified 9 patients with Sugaya type I, 28 patients with type II, and 24 patients with type III repairs. No patients showed Sugaya type IV or V repairs at postoperative 3 months. Thirty-seven patients who had shown Sugaya type I or II repairs on 3-month postoperative MRI had no retear on imaging study at a minimum of 1 year. Of 24 patients who had shown type III repairs on 3-month postoperative MRI, 1 patient exhibited retear (Sugaya type IV) on 1-year postoperative MRI and 3 patients showed full-thickness retear on 1-year postoperative ultrasonography. All 4 of these patients had had large to massive tears preoperatively.

Conclusion: Retears occurred infrequently in the late postoperative period (after 3 months) in well-healed tendons that had shown intact cuff repair integrity with sufficient mechanical and biological healing within the first 3 postoperative months.

Keywords: cuff healing process; cuff integrity; rotator cuff repair; rotator cuff retear; timing of retear.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroscopy
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Postoperative Period
  • Range of Motion, Articular
  • Recurrence
  • Rotator Cuff / surgery
  • Rotator Cuff Injuries*
  • Shoulder Injuries*
  • Shoulder Joint / surgery
  • Time Factors
  • Treatment Outcome
  • Wound Healing