Complications within 6 months after arthroscopic rotator cuff repair: registry-based evaluation according to a core event set and severity grading

Purpose: To report complications after arthroscopic rotator cuff repairs (ARCRs) from a large patient cohort based on clinical application of a newly-defined core event set (CES) and severity grading.

Methods: Consecutive primary ARCRs documented in a local clinical registry between 2010 and 2016 were included. Clinicians documented adverse events (AEs) reported until the final 6-month postoperative follow-up according to the CES. The CES is an organized list of relevant AEs sorted into three intraoperative (device, osteochondral, soft tissue) and nine postoperative event groups (device, osteochondral, pain, rotator cuff, surgical-site infection, peripheral neurologic, vascular, superficial soft tissue, deep soft tissue). Severity was determined using an adapted Clavien-Dindo classification. Cumulative complication risks were calculated per event group and stratified by severity and the extent of rotator cuff tear.

Results: 1,661 repairs were documented in 1,594 patients (mean, 57 years [standard deviation, 9]; 38% women); 21% involved partial tears. All events were recorded according to the CES. Intraoperative events occurred in 2.2%. 329 postoperative events were identified in 307 repairs (305 patients); 93% had one AE. The cumulative AE risk at 6 months was 18.5%; AE risks were 21.8% for partial tears, 15.8% for full-thickness single-tendon tears, 18.0% and 25.6% for two- and three-ruptured tendon tears, respectively. AE risks per event group were: 9.4% for deep soft tissue with shoulder stiffness (7.6%) being the most common event; persistent/worsening pain (3.4%); rotator cuff defects (3.1%); neurological lesions (1.7%); surgical site infection (0.8%); device (0.7%); osteochondral (0.4%); superficial soft tissue (0.2%) and vascular (0.1%). The majority of AEs had severity grades I (160 [49%]) and II (117 [36%]).

Conclusion: Comprehensive local AE documentation according to the CES and severity grading was possible and showed that about 1/5 of ARCRs were affected, mostly by one AE of low severity. Shoulder stiffness was the most frequent event.