These authors point out that retear and nonhealing of a surgically repaired rotator cuff are common. They aimed to determine the relationship between preoperative and intraoperative factors and retear rate following rotator cuff repair using data from 1962 consecutive patients who underwent a primary arthroscopic single-row rotator cuff repair performed by an individual surgeon from 2007 through 2018 and postoperatively returned for 6-month follow-up ultrasonography.
The mean patient age at surgery was 59 years. 1156 of the tears were full thickness whereas 806 were partial thickness.
The mean anteroposterior tear length was 1.8 cm, and the mean mediolateral tear length was 1.6 cm The mean value of their resultant product (tear size area) was 3.7 cm2.
On average, 2 suture anchors were used, and repairs required 20 minutes.
1583 repairs were performed in a private hospital whereas 107 were performed in a public hospital.
At 6-month follow-up, 1691 rotator cuff repairs were found to be intact whereas 271 (14%) had retorn or not healed.
Patients who had retears at 6 months were more likely to be men, to be older, and to present with a full-thickness tear rather than partial-thickness tear. Their repairs required more suture anchors and a longer operative time. Intraoperatively, significantly greater anteroposterior and mediolateral tear lengths were found in the retear group than in the intact group. Consequently, the mean intraoperative tear size area was approximately 2.5 times greater among retears as compared with intact tendons.
The data indicated that following rotator cuff repair, there was a 4-fold increase in the retear rate as the anteroposterior tear size increased from 1 cm to 3 cm; a 8-fold decrease when comparing case number 1000 with case number 3000; a 2-fold increase as patient age increased from 50 years to 70 years; and a 3-fold increase when comparing surgery performed in a public hospital vs. a private hospital.
Case number was used as a proxy measure for overall progress over time in the rotator cuff repair and rehabilitation process, encompassing factors including surgical experience and rehabilitation experience. An increased case number may have reduced retears via factors including increased surgical experience and improved, less aggressive rehabilitation protocols throughout the course of the study.
With respect to the role of hospital type in rotator cuff retear the authors suggest that the effect may be explained by factors including disparate patient factors such as socioeconomic status between the 2 groups or younger surgeons assisting in rotator cuff repairs under the supervision of the senior author in the public hospital. Furthermore, the private hospital may have had superior operating room equipment in addition to more experienced staff that may have led to lower retear rates; moreover, a preoperative rehabilitation education clinic was freely available to patients treated in the private hospital.
Comment: This is a large study with carefully analyzed data from a high volume Australian shoulder surgeon. The tears repaired in this series were small (average AP dimension <2cm) and included a substantial number of partial thickness tears. AP tear size, hospital experience, patient age and hospital type emerged as the most important factors associated with retear. The relationship of repair integrity to patient reported outcome was not explored in this study.
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