title: The influence of intraoperative factors and postoperative rehabilitation compliance on the integrity of the rotator cuff after arthroscopic repair.
abstract: 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 6 weeks, 12 weeks, and 26 weeks 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 12 weeks than in the second 12 weeks 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 6 weeks 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.
authors.affiliation: Sports Injury Unit, Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Shahrulazua
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Shoulder Unit, Department of Orthopaedics, Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia. Electronic address: markdhaber@gmail.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Haber
authors.affiliation: Shoulder Unit, Department of Orthopaedics, Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Desmond J
authors.initials: DJ
authors.lastname: Bokor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011184:Postoperative Period; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000534:rehabilitation / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Arthroscopy; recurrence; rehabilitation; rotator cuff; tears; tendons; ultrasound