Greater Tuberosity Bone Mineral Density and Rotator Cuff Tear Size Are Independent Factors Associated With Cutting-Through in Arthroscopic Suture-Bridge Rotator Cuff Repair

Lee, Sanghyeon; Hwang, Jung-Taek; Lee, Sang-Soo; Lee, Jun-Hyuck; Kim, Tae-Yeong

doi:10.1016/j.arthro.2021.01.059

Cited by 11 publications

(11 citation statements)

References 33 publications

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“…Several studies evaluating the relationship between various patient-related factors and retear have emphasized the influence of structural factors, such as tear size and tendon quality, on repaired tendon integrity. 17,20,21,24,32 Unlike previous studies, our study found that a 10-year ASCVD risk score was the independent predictor of retear. Of the factors included in ASCVD risk calculation, age, diabetes, hyperlipidemia, and smoking overlapped with factors related to retear reported in previous studies.…”

Section: Discussioncontrasting

confidence: 99%

“…26 The incidence of rotator cuff repairs also has increased in older patients because of increased life expectancy and high functional demands. 24,32 Therefore, the intersection of arthroscopic rotator cuff repair and hyperlipidemia is increasing over time. A number of experimental studies have suggested that hyperlipidemia and statin use were associated with tendon healing because elevated serum lipid levels impair tendon-to-bone healing.…”

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confidence: 99%

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Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair

Lee¹,

Lee

Shin

2023

Am J Sports Med

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Background: There is no practical consensus on managing cholesterol in patients with rotator cuff repair despite hyperlipidemia and statin therapy being well-known factors in rotator cuff healing. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score is a commonly used guideline to determine statin administration for hyperlipidemia. Purpose: To identify the relationship between retear and preoperative factors, including 10-year ASCVD risk score and statin administration status, and to compare clinical outcomes and retear rates between patients who are taking and not taking statins. Study Design: Case-control study; Level of evidence, 3. Methods: This study enrolled 182 patients with a symptomatic full-thickness rotator cuff tear who underwent arthroscopic repair. Serum lipid profile, 10-year ASCVD risk score, statin eligibility, and statin administration status were assessed. Patients were categorized into 2 groups based on magnetic resonance imaging to evaluate cuff integrity at postoperative 6 months: a healed group and a retear group. Radiographic and intraoperative factors related to retear were analyzed. Multiple regression analysis was performed to evaluate factors related to rotator cuff retear. For the subgroup analysis, patients eligible for statin therapy were divided into 2 subgroups according to administration status. Results: There were 149 (81.9%) patients in the healed group and 33 (18.1%) in the retear group. In the multiple regression analysis, missed statin therapy, 10-year ASCVD risk score, and fatty infiltration of the infraspinatus muscle were the independent factors related to retear. The cutoff value for 10-year ASCVD risk score was 11.85%, with a sensitivity of 0.75 and a specificity of 0.62. In the subgroup analysis of 104 patients eligible for statin therapy, 66 (63.5%; group 1) received statin therapy and 38 (36.5%; group 2) missed it. Group 2 showed a significantly higher retear rate than group 1 (36.8% vs 13.6%; P = .006). Conclusion: Missed statin therapy, 10-year ASCVD risk score, and fatty infiltration of the infraspinatus were the independent factors associated with rotator cuff retear. Patients who missed statin therapy showed a higher retear rate than patients receiving statin therapy. Optimal statin therapy for patients who undergo arthroscopic rotator cuff repair might improve repair integrity.

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Section: Discussioncontrasting

confidence: 99%

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confidence: 99%

Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair

Lee¹,

Lee

Shin

2023

Am J Sports Med

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“…The lateral row of anchors is known to be the most biomechanically vulnerable, 2,6 and this is often due to failure of the anchors in the bone. The lateral row anchors can toggle in the relatively soft bone of the lateral humerus, 7 with the cortical end of the screw tilting proximally under the load of the FiberTape suture (Fig 3). This will detension the suture construct, and the supraspinatus tendon often lifts away from the greater tuberosity of the humerus as the shoulder moves and the anchor toggles.…”

Section: Discussionmentioning

confidence: 99%

“…This often happens in patients who are elderly or have reduced bone mineral density in the greater tuberosity. 7 We describe fixation of the rotator cuff using the Arthrex SpeedbridgeÔ technique with the addition of a third-row "tripod anchor," using a guy wire principle, to support the lateral anchors. The guy wire principle is often used in construction to add stability to a structure and resist a predictable load.…”

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Tripod Technique to Augment Transosseous Equivalent Rotator Cuff Repair

Gaukroger

Arnander

Pearse

et al. 2022

Arthroscopy Techniques

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“…2 We read with interest the article by Lee, Hwang, Lee, Lee, and Kim entitled "Greater Tuberosity Bone Mineral Density and Rotator Cuff Tear Size Are Independent Factors Associated With Cutting-Through in Arthroscopic Suture-Bridge Rotator Cuff Repair." 10 This clinical paper documents a potential alternative method of failure with the suture cutting through the bone in patients with low BMD at the time of surgery. While suture cutting through the bone has been documented previously in biomechanical studies, 11 this is the first clinical study of which we are aware to document its occurrence on a prospective basis.…”

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confidence: 99%

Editorial Commentary: Causes of Failure After Arthroscopic Rotator Cuff Repair

Rashid

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Causes of failure after arthroscopic rotator cuff repair include patient factors, tear factors, and surgical factors. Failure may occur at the sutureetendon interface, the boneetendon interface, or the boneeanchor interface. Low bone mineral density (BMD) in the greater tuberosity has been reported as a prognostic factor for recurrent tears following rotator cuff repair, and although most studies suggest the tendon-to-suture interface as the "weakest link," patients with low BMD may have lower suture anchor pull-out strength. A potential alternative cause of failure is the suture cutting through the greater tuberosity bone in patients with low BMD. Knotless suture bridge constructs or single-row constructs may be more susceptible to a suture cutting through the bone. The knotted suture bridge technique, wherein the medial mattress sutures are tied, may to some extent "shield" against complete cut-through. When bone quality appears poor, a common response is to change the type of anchor, size of anchor, or the location of the anchor. Other factors, such as bone preparation, suture type, suture tensioning, and anchor type (e.g., internal vs external locking), may all potentially affect suture cutting through weak bone.

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Greater Tuberosity Bone Mineral Density and Rotator Cuff Tear Size Are Independent Factors Associated With Cutting-Through in Arthroscopic Suture-Bridge Rotator Cuff Repair

Cited by 11 publications

References 33 publications

Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair

Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair

Tripod Technique to Augment Transosseous Equivalent Rotator Cuff Repair

Editorial Commentary: Causes of Failure After Arthroscopic Rotator Cuff Repair

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