title: Retear rate in the late postoperative period after arthroscopic rotator cuff repair.
abstract: BACKGROUND
  Few clinical studies have evaluated the integrity of repaired tendons and identified the timing of retears through the use of serial imaging.
  
  
  OBJECTIVE
  Retears after arthroscopic rotator cuff repair are uncommon in the late postoperative period (after 3 months).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea drjkim@cha.ac.kr.
authors.forename: Jae Hwa
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
authors.forename: In Tae
authors.initials: IT
authors.lastname: Hong
authors.affiliation: Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
authors.forename: Keun Jung
authors.initials: KJ
authors.lastname: Ryu
authors.affiliation: Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
authors.forename: Sun Tae
authors.initials: ST
authors.lastname: Bong
authors.affiliation: Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea.
authors.forename: Yoon Seok
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
authors.forename: Jang Hwan
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016059:Range of Motion, Articular; D012008:Recurrence; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
keywords: cuff healing process; cuff integrity; rotator cuff repair; rotator cuff retear; timing of retear