McColl Alexander H, Lam Patrick H, Murrell George A C
Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, NSW, Australia.
JSES Open Access. 2019 Mar 11;3(1):12-20. doi: 10.1016/j.jses.2019.01.002. eCollection 2019 Mar.
Postoperative retear is the most common surgical complication after rotator cuff repair. This study aimed to determine whether there had been any improvements in rotator cuff repair integrity in our center and to identify any changes in the management of rotator cuff tears that may have impacted postoperative retear rate.
This retrospective observational single cohort study used running average analysis to examine 1600 consecutive patients over 8 years, who underwent primary arthroscopic rotator cuff repair by a single surgeon, and had cuff integrity assessed by ultrasound 6 months after operation.
Retear rates ranged from 3% to 34%, with a mean of 15%. Over our study retear rates decreased from 18% to 5%. Reductions in retear rates were associated with less aggressive rehabilitation, postoperative abduction sling use, and increased surgical experience. Increases in retear rates were associated with increased false positives with a more sensitive ultrasound machine and learning curves with new equipment for a surgeon and sonographer.
A decrease in retear rate after arthroscopic rotator cuff repair occurred during our study. Although the study design prevents us from directly attributing changes in retear rate to changes in management, our results suggest that rehabilitation optimization and increased surgeon experience decrease postoperative retear.
术后再撕裂是肩袖修复术后最常见的手术并发症。本研究旨在确定我们中心肩袖修复的完整性是否有任何改善，并确定肩袖撕裂治疗方法中可能影响术后再撕裂率的任何变化。
这项回顾性观察单队列研究采用移动平均分析，对8年间连续1600例患者进行了检查，这些患者均由同一位外科医生进行初次关节镜下肩袖修复，并在术后6个月通过超声评估肩袖完整性。
再撕裂率在3%至34%之间，平均为15%。在我们的研究中，再撕裂率从18%降至5%。再撕裂率的降低与康复治疗不那么激进、术后使用外展吊带以及手术经验增加有关。再撕裂率的增加与使用更灵敏的超声机器导致假阳性增加以及外科医生和超声检查人员使用新设备的学习曲线有关。
在我们的研究期间，关节镜下肩袖修复术后再撕裂率有所下降。虽然研究设计使我们无法直接将再撕裂率的变化归因于治疗方法的改变，但我们的结果表明，优化康复治疗和增加外科医生经验可降低术后再撕裂率。
