Original Article
Morphologic Risk Factors in Predicting Symptomatic Structural Failure of Arthroscopic Rotator Cuff Repairs: Tear Size, Location, and Atrophy Matter

https://doi.org/10.1016/j.arthro.2016.01.067Get rights and content

Purpose

To evaluate whether morphologic characteristics of rotator cuff tear have prognostic value in determining symptomatic structural failure of arthroscopic rotator cuff repair independent of age or gender.

Methods

Arthroscopic rotator cuff repair cases performed by five fellowship-trained surgeons at our institution from 2006 to 2013 were retrospectively reviewed. Data extraction included demographics, comorbidities, repair technique, clinical examination, and radiographic findings. Failure in symptomatic patients was defined as structural defect on postoperative magnetic resonance imaging or pseudoparalysis on examination. Failures were age and gender matched with successful repairs in a 1:2 ratio.

Results

A total of 30 failures and 60 controls were identified. Supraspinatus atrophy (P = .03) and tear size (18.3 mm failures v 13.9 mm controls; P = .02) were significant risk factors for failure, as was the presence of an infraspinatus tear greater than 10 mm (62% v 17%, P < .01). Single-row repair (P = .06) and simple suture configuration (P = .17) were more common but similar between groups. Diabetes mellitus and active tobacco use were not significantly associated with increased failure risk but psychiatric medication use was more frequent in the failure group.

Conclusions

This study confirms previous suspicions that tear size and fatty infiltration are associated with failure of arthroscopic rotator cuff repair but independent of age or gender in symptomatic patients. There is also a quantitative cutoff on magnetic resonance imaging for the size of infraspinatus involvement that can be used clinically as a predicting factor. Although reported in the literature, smoking and diabetes were not associated with failure.

Level of Evidence

Level III, retrospective case control.

Section snippets

Methods

Institutional review board approval was obtained. Medical records for patients undergoing arthroscopic rotator cuff repair by five fellowship-trained surgeons at a single institution from 2006 to 2013 were queried and retrospectively reviewed. Arthroscopic rotator cuff repair failure was defined by our inclusion criteria, which were symptomatic patients with structural defect on postoperative magnetic resonance imaging (MRI) or pseudoparalysis on clinical examination, defined as active forward

Demographics

We identified 30 cases of symptomatic arthroscopic rotator cuff repair failure and 60 controls. The average age of diagnosis of the failure group was 55.1 (σ = 9.3) years versus 54.9 (σ = 8.1) years for the control group (Table 1). Female patients accounted for 40% of each group. There were no significant differences between the failure group compared with the controls in body mass index (28.8 v 30.5, P = .18) or age at symptom onset (54.5 v 54.1, P = .84) (Table 1). Similarly, no significant

Discussion

Supraspinatus tear size and fatty infiltration in addition to infraspinatus tears greater than 10 mm (Table 2) were predictive of failure in our study, supporting our hypothesis. MRI confirmed these cases on average 10 months after surgery in 90%, whereas pseudoparalysis detected the other 10%. Several studies focusing on all-arthroscopic repair have reported recurrence rates of structural failure from 11% to 94%.1, 5 The 2010 American Academy of Orthopaedic Surgeons clinical practice

Conclusions

This study confirms previous suspicions that tear size and fatty infiltration are associated with failure of arthroscopic rotator cuff repair but independent of age or gender in symptomatic patients. There is also a quantitative cutoff on MRI for the size of infraspinatus involvement that can be used clinically as a predicting factor. Although reported in the literature, smoking and diabetes were not associated with failure.

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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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