Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleMorphologic Risk Factors in Predicting Symptomatic Structural Failure of Arthroscopic Rotator Cuff Repairs: Tear Size, Location, and Atrophy Matter
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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See commentary on page 1953
The authors report that they have no conflicts of interest in the authorship and publication of this article.