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Scientific Articles   |    
Time to Failure After Rotator Cuff RepairA Prospective Imaging Study
Joseph P. Iannotti, MD, PhD1; Allen Deutsch, MD2; Andrew Green, MD3; Sally Rudicel, MD4; Jared Christensen, PhD4; Shannon Marraffino4; Scott Rodeo, MD5
1 Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195. E-mail address: iannotj@ccf.org
2 Kelsey Seabold Clinic, 2727 West Holcombe Boulevard, Houston, TX 77025
3 University Orthopaedics, Inc., Medical Office Center, Suite 2002, Dudley Street, Providence, RI 02905
4 Pfizer, 35 Cambridge Park Drive, Cambridge, MA 02140
5 Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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  • Disclosure statement for author(s): PDF

Investigation performed at the Cleveland Clinic, Cleveland, Ohio; Kelsey Seabold Clinic, Houston, Texas; University Orthopedics, Providence, Rhode Island; Hospital for Special Surgery, New York, NY; Mount Sinai Medical Center, New York, NY; Massachusetts General Hospital, Boston, Massachusetts; CORE Institute, Phoenix, Arizona; Everett Clinic, Everett, Washington; University of Rochester Medical Center, Rochester, New York; Texas Orthopedic Specialists, Bedford, Texas; UCSF, San Francisco, California; and Yale University, New Haven, Connecticut

A commentary by Robert H. Brophy, MD, is linked to the online version of this article at jbjs.org.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jun 05;95(11):965-971. doi: 10.2106/JBJS.L.00708
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Abstract

Background: 

Failure of tendon healing after a rotator cuff repair is demonstrated by magnetic resonance imaging (MRI) as a fluid-filled defect within the tendon. The frequency of, and factors associated with, failure of the tendon repair to heal have been the focus of many clinical studies. The timing of when these defects occur has not been previously studied in a large prospectively defined patient population, to our knowledge. It was our hypothesis that the majority of failures occur within twelve weeks after surgery.

Methods: 

One hundred and thirteen patients were enrolled in a multi-institutional prospective study. All patients had a standardized arthroscopic repair of a full-thickness tear of 1 to 4 cm as well as sequential MRI studies at six intervals from two weeks to fifty-two weeks. MRIs were reviewed at the time of imaging by the treating surgeon. Standardized patient-oriented clinical data were collected, physical examination was performed, and strength measurements were made preoperatively and postoperatively.

Results: 

The treating surgeons diagnosed a recurrent tear with MRI in nineteen (17%) of the 113 patients within one year after surgery. The mean time to the retear was 19.2 weeks. There was a linear increase in retears over the first twenty-six weeks after surgery, and one additional tear was diagnosed between twenty-six and fifty-two weeks after repair.

Conclusions: 

Retears primarily occur between six and twenty-six weeks after arthroscopic rotator cuff repair, and few additional tears occur thereafter. A substantial number of retears occur between twelve and twenty-six weeks after repair.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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