TY - JOUR
T1 - The Influence of intraoperative factors and postoperative rehabilitation compliance on the integrity of the rotator cuff after arthroscopic repair
AU - Ahmad, Shahrulazua
AU - Haber, Mark
AU - Bokor, Desmond J.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - 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 6weeks, 12weeks, and 26weeks 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 12weeks than in the second 12weeks 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 6weeks 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.
AB - 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 6weeks, 12weeks, and 26weeks 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 12weeks than in the second 12weeks 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 6weeks 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.
KW - arthroscopy
KW - recurrence
KW - rehabilitation
KW - rotator cuff
KW - tears
KW - tendons
KW - ultrasound
UR - http://www.scopus.com/inward/record.url?scp=84920721201&partnerID=8YFLogxK
U2 - 10.1016/j.jse.2014.06.050
DO - 10.1016/j.jse.2014.06.050
M3 - Article
C2 - 25240808
AN - SCOPUS:84920721201
SN - 1058-2746
VL - 24
SP - 229
EP - 235
JO - Journal of Shoulder and Elbow Surgery
JF - Journal of Shoulder and Elbow Surgery
IS - 2
ER -