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

Abstract

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.

Differences in Clinical Outcomes Between Patients With Retear After Supraspinatus Tendon Repair and Those With Intact Repair at 5-Year Follow-up

“…In the current retrospective study, revision surgery was required in fewer than one-fourth of patients who had full-thickness cuff retear. Despite the presence of full-thickness retear in the repaired tendon, 77% and 69% of cuff retear patients who received nonoperative treatment for a failed repair achieved MCID in VAS and ASES scores, respectively, which was considered a ''good prognosis'' by Kim et al 21 Even if a full-thickness retear is found in the postoperative period, patients who receive rotator cuff repair should be given an adequate length of rehabilitation because some of them will continue to improve, despite the presence of full-thickness retear.…”

“…Patient-reported outcomes generally improve regardless of whether the repaired tendon is intact. 24 Kim et al 21 reported that 71% of patients with full-thickness retear of the repaired tendon were considered to have a good prognosis because they achieved MCID in functional score assessment. Similar observations were found in the current study.…”

“…However, radiological failure in terms of full-thickness retear after rotator cuff repair does not necessarily equate to a poor prognosis. 21 It has been observed that the patient-reported outcomes generally improve regardless of whether the repair is intact or complicated by cuff retear. 2 In another study, no difference was observed in clinical outcomes, including visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion (FF) of the involved shoulder, between the cuff retear group and the intact repair group at a short-term follow-up of 2 years.…”

Factors affecting medium-term patient satisfaction after arthroscopic repair of small to medium-sized rotator cuff tears: An observational study

“…[7] Reported results were worse in patients with tears that progressed to a greater size compared to their preoperative size. [6,8] This study aimed to assess the effect of the healing status and integrity of the tendon at the last follow-up, and to clarify the effect of various variables on patient satisfaction at a minimum of 5 years after arthroscopic RC repair. The hypothesis was that tears that had progressed (tear size similar or increased compared to the preoperative MRI) at the last follow-up would be correlated to a lesser degree of satisfaction.…”

“…[ 7 ] Reported results were worse in patients with tears that progressed to a greater size compared to their preoperative size. [ 6 , 8 ]…”