The duration of surgery and rotator cuff repair retear rates decreases as the surgical team gains experience, a new study finds.
Surgery Time, Rotator Cuff Retears Lessen With Surgeon Experience
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The authors of “Duration of Surgery and Learning Curve Affect Rotator Cuff Repair Retear Rates: A Post Hoc Analyses of 1600 Cases,” published online on October 13, 2020 in the Orthopaedic Journal of Sports Medicine, hypothesized that shorter operative times would translate to fewer rotator cuff retears at 6 months postoperatively.
The evidence did not support their hypothesis; however, operative times and retear rates did decrease as the surgical team performed more rotator cuff repair cases.
A retear is the most common complication after rotator cuff repair, with reported retear rates ranging between 15% and 90%.
The analyses included 1,600 consecutive patients; 670 had partial-thickness tears while 930 had full-thickness tears. All rotator cuff retears were performed by a single surgeon using an arthroscopic, single-row, knotless inverted mattress suture anchor technique.
The mean operating time for early cases was approximately 35 minutes. After about 450 cases, that time decreased to 20 minutes. The mean retear rate was 13%.
Increased operative time was associated with a retear (r = 0.18; p < .001). However operative time was not a significant independent factor for retear risk.
Multiple logistic regression analysis revealed that the variables with the most independent effect on retears were larger tear size (Wald statistic = 36; p < .001), lower case number (i.e., less surgeon experience) (Wald statistic = 28; p < .001), older patient age (Wald statistic = 23; p < .001), full-thickness tears (Wald statistic = 13; p < .001), and lower surgeon-rated repair quality (Wald statistic = 8; p = .004).
The researchers wrote, “The reduced retear rate wasn’t related to a reduction in operative time per se, but rather to improved surgical team experience and patient factors such as improved healing with smaller tears in younger patients.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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