Kim IB, et al. Arthroscopy. 2016;doi:10.1016/j.arthro.2016.03.012.
April 12, 2017
Duration of symptoms before surgery of full-thickness rotator cuff tears, tear size and tendon involvement may be used to preoperatively predict retear after arthroscopic repair using the suture bridge technique, according to results of this prognostic case series.
Researchers identified 282 patients who underwent arthroscopic rotator cuff tear repair between January 2009 and May 2013. Researchers considered patient age, sex, diabetes and smoking status, symptom duration before surgery, tear size, tendon involvement and degree of fatty degeneration of the supraspinatus and infraspinatus as factors associated with the retear of a repaired rotator cuff. The Kim classification and the modified DeOrio and Cofield classification were used to measure tear size, according to researchers.
Results showed an overall retear rate of 13.1%. While age, sex, diabetes, smoking and degree of fatty degeneration of the supraspinatus and infraspinatus did not affect retear rates, researchers noted retear rates were affected by symptom duration, Kim classification and tendon involvement.
Patients who had symptoms for fewer than 12 months and those who had symptoms for at least 12 months had retear rates of 8.5% and 19.7%, respectively. Researchers also found retear rates of 8%, 15.2% and 57.1% in Kim classification groups I, II and III, respectively. They also found retear rates of 6.6% among patients with the supraspinatus involved, of 22.2% among patients with the supraspinatus and subscapularis involved, of 10% among patients with the supraspinatus and infraspinatus involved and of 42.9% among patients with all three of these tendons involved. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.
Perspectives
Rotator cuff repairs continue to be a challenging problem due to high retear rates. In a recently published study by Kim and colleagues, they evaluated 282 isolated repairable rotator cuff tears with a postoperative MRI and 2-year follow-up. Significant clinical improvements were seen in patients with and without retears. The authors found retear rates were not affected by age, sex, diabetes, smoking or Goutallier stage. Factors they did find correlated with retear rates included amount retracted, number of tendons (particularly for tears that included both the supraspinatus and subscapularis) and duration of symptoms.
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This article reinforces previous studies emphasizing the importance of considering the shoulder as an organ and the associated biologic considerations related to the muscle, tendon and bone. The authors noted tendon retraction medial to the glenoid will result in a high failure rate. Interestingly, the duration of symptoms did not correlate with the tear size; however, it did correlate with retear rates. Furthermore, this article challenges the notion that fatty degeneration affects healing rates. As noted in this study, that may be the result of selection bias and their method of grouping patients for analysis. Lastly, although not a clinically significant difference, the authors did find higher outcome scores in those with healed repairs. This is a critical take-home point as current paradigms that emphasize that clinical outcomes are similar independent of the cuff anatomy at follow-up are repeatedly challenged by contemporary literature, indicating that the integrity of the repair is correlated with clinical outcomes, especially function and strength.
Most of the conclusions in this study reinforce similar conclusions from previous studies and provide useful preoperative criteria that can identify risk factors for rotator cuff retearing. It is interesting to note the overall low retear rate of 13.1% using the double row transosseous equivalent repair. This supports some prior literature that suggest biomechanical superiority and reduced retear rates. While the debate continues related to repair techniques, this study does clearly reinforce some of the most basic tenants of what is known biomechanically and clinically in contemporary literature.
- Brian J. Cole, MD, MBA
- Associate chairman and professor,
Department of orthopedics,
Rush University Medical Center,
Chicago– David D. Savin, MD
Rush University Medical Center,
Chicago