Poor Prognostic Factors in Patients With Rotator Cuff Retear

Background: Anatomic repair of a torn rotator cuff tendon on the greater tuberosity (GT) is an important surgical goal in rotator cuff repair. However, few studies have investigated whether the efforts made to maximize coverage of the GT are associated with the clinical and structural outcomes after rotator cuff repair surgery. Purpose: To investigate whether the quality of repair at the time of surgery is associated with clinical and structural outcomes after surgery and to identify factors influencing the quality of repair. Study design: Cohort study; Level of evidence, 3. Methods: Data were retrospectively collected from 141 patients who underwent arthroscopic rotator cuff repair between 2008 and 2016. All repairs were classified according to the amount of postoperative GT coverage: A, complete coverage of the GT (n = 96); B, incomplete coverage, comprising more than half of GT (n = 27); C, incomplete coverage, comprising less than half of the GT (n = 16); and D, exposure of the glenohumeral joint (n = 2). All patients underwent magnetic resonance imaging 1 year after surgery. Clinical outcomes and structural integrity based on Sugaya classification were assessed 2 years and 1 year after surgery, respectively. Preoperative factors associated with the postoperative GT coverage (measured at the close of surgery) were identified using a multivariable proportional odds cumulative logit model. Results: The forward flexion strength in group A (10.3 ± 4.6 lb) was significantly greater than that in group C (6.5 ± 3.7 lb) ( P = .003) 2 years after surgery. The postoperative Constant score in group A (76.6 ± 11.5) was greater than that in group C (66.7 ± 15.6) ( P = .018). The number of cases that showed retearing of the repaired tendon was as follows: group A (5/96; 5.2%), group B (7/27; 25.9%), and group C (10/16; 62.5%). There was no significant difference in the changes of pain visual analog scale scores among groups 2 years after surgery (all P > .05). Also, there was no significant difference in the changes of range of motion in all directions among groups 2 years after surgery (all P > .05). Patients with preoperative GT coverage B included in the postoperative GT coverage groups through surgery were as follows: group A (23/45; 51.1%), group B (17/45; 37.8%), and group C (5/45; 11.1%). Preoperative GT coverage was the only independent factor that was associated with GT coverage in multivariable analysis. Conclusion: Quality of repair, measured as the extent of postoperative GT coverage at the time of surgery, was associated with clinical and structural outcomes after rotator cuff repair surgery.

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 94%

Effect of Quality of Repair on Clinical and Structural Outcomes of Rotator Cuff Repair

Park

et al. 2022

“…20 It is also argued that successful healing of the rotator cuff tendon does not correlate with clinical improvement of symptoms or patient satisfaction. 15 The negative effect of a retear on outcome was inconsistent across the various functional scores in our review and…”

Section: Discussionmentioning

confidence: 72%

“…The mean age was 56.3 years (range, 25-77) and the mean follow-up was 14.0 years (range, 9-20). Five studies 12,21,[31][32][33] reported on aRCR outcomes while 6 studies provided outcomes after open 3,23 or mini-open 1,5,7,23,36 rotator cuff repairs ( [10][11][12][13][14][15][16][17][18][19][20]. There were no significant demographical differences between the groups (P = .886).…”

Section: Study Characteristicsmentioning

confidence: 99%

A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs

Plachel

Rüttershoff

et al. 2022

Background: Arthroscopic rotator cuff repair (aRCR) has shown similar midterm functional results and retear rates as open/mini-open rotator cuff repair (oRCR). A pooled analysis of long-term results of both techniques is yet missing. Purpose: To evaluate the long-term results of aRCR and oRCR for full-thickness rotator cuff tears. Study Design: Systematic review; Level of evidence, 4. Methods: The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CENTRAL (Cochrane), MEDLINE (PubMed), and Embase databases were searched for studies that reported on long-term clinical and radiographic outcomes of full-thickness aRCR and oRCR with a minimum follow-up of 9 years. Results: Eleven studies were included: 5 studies on aRCR and 6 studies on oRCR. Studies were based on 550 shoulders (539 patients) with a mean patient age of 56.3 years (range, 25-77). After a mean follow-up of 14.0 years (range, 9-20), the mean preoperative absolute Constant score (CS) and American Shoulder and Elbow Surgeons (ASES) shoulder score were significantly improved postoperatively (CS, 44 to 78 points; ASES, 52% to 91%; both comparisons, P < .001). The retear rate was 41% (141 of 342 shoulders) without a significant difference between groups (aRCR, 43%; oRCR, 39%) ( P = .364). A retear was associated with significantly reduced CS as compared with a healed repair ( P = .004). No significant differences were found in postoperative functional scores, complications, and retear rates after failed cuff repairs between the arthroscopic and open/mini-open repair groups. Conclusion: Pooled analysis of arthroscopic and open rotator cuff repairs demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. There were no significant differences in long-term functional outcomes, retear rates, and complications. Both surgical techniques may be used on the basis of factors such as patient or surgeon preference and cost. Further studies using a more robust randomized controlled trial or larger cohort design are recommended to ascertain whether one surgical repair technique is superior to the other. Registration: CRD42020180448 (PROSPERO).

“…Lee et al 30 revealed that the possibility of revision surgery was higher in patients who had relative changes in the AP tear size of >14.6% compared with patients who did not require revision surgery. According to Kim et al, 22 revision surgery should be considered in female patients or those who smoke with poor clinical outcomes and a larger retear than the preoperative tear size.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors Leading to Good or Poor Outcomes Based on Functional and Radiological Findings After a Rotator Cuff Retear

Kim

Lee

et al. 2022

Background: A retear after rotator cuff repair is a common problem; however, there is little information related to the prognosis after a retear. In addition, some patients with retears have satisfactory outcomes, which raises the question of whether a retear leads to a poor prognosis. Purpose: To identify radiological factors that influence the prognosis after a retear. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 51 patients with retears confirmed by magnetic resonance imaging at 1 year after arthroscopic rotator cuff repair with a minimum follow-up of 24 months were enrolled in this study. Patients were divided into 2 groups according to whether they achieved the minimal clinically important difference for clinical outcome measures. Range of motion and radiological variables, including preoperative and postoperative anteroposterior (AP) and mediolateral (ML) tear sizes, sagittal extent of the retear, acromiohumeral distance (AHD), and degree of fatty degeneration, were analyzed using magnetic resonance imaging. Results: Overall, 36 patients were allocated to the good prognosis (GP) group and 15 to the poor prognosis (PP) group. The 2 groups had no significant differences in baseline demographics and preoperative radiological parameters. Postoperative range of motion was decreased in the PP group at the last follow-up. The AP and ML retear sizes decreased in both groups after arthroscopic rotator cuff repair, but the retear size was significantly larger in the PP group (both P < .05). The AHD increased in the GP group ( P < .001) but decreased in the PP group ( P = .230) postoperatively. Logistic regression analysis revealed that postoperative AHD ( P = .003), fatty degeneration of the infraspinatus tendon ( P = .001), posterior ( P = .007) and anterior ( P = .025) sagittal extent of the retear, and change in the AP tear size ( P = .017) were related to poor outcomes after a retear. However, change in the ML tear size ( P = .105) and middle sagittal extent of the retear ( P = .878) were not related to a poor prognosis. Also, further analysis showed that posterior ( P = .006) and anterior ( P = .003) sagittal extent of the retear were related to rotator cable involvement. Conclusion: An increased AP retear size and decreased AHD were radiological parameters that were associated with poor clinical outcomes after a retear. In particular, patients who had posterior and anterior sagittal extent of the retear, possibly with rotator cable involvement and more severe fatty degeneration of the infraspinatus tendon, showed worse outcomes.