Factors associated with the development of re-tear following arthroscopic rotator cuff repair: A retrospective comparative study

The effect of reduced acromiohumeral distance and increased acromial thickness on the risk of rotator cuff tear

OBJECTIVE

This study aimed to determine the effect of reduced acromiohumeral distance (AHD) and increased acromial thickness (AT) on the risk of rotator cuff tear (RCT).

METHODS

Patients aged 25-70 were included in this retrospective study. Patients who were operated on for RCT between January 2019 and December 2021 were included in group 1, and patients who applied to the outpatient clinic in the same period with a complaint of shoulder pain and no problem on magnetic resonance imaging (MRI) were included in group 2. Three researchers performed AHD and AT measurements on the same true anteroposterior (AP) shoulder radiographs. The second measurement was performed 1 month later when, the first measurements were completed.

RESULTS

Radiographs of 284 patients in group 1 and 234 patients in group 2 were evaluated. In group 1, the mean AHD measurement was 8.25 ± 1.73 mm, and the AT measurement was 8.58 ± 1.06 mm. In group 2, the mean AHD measurement was 10.25 ± 1.4 mm, and the AT measurement was 8.35 ± 0.92 mm. A significant relationship was determined between the RCT and the AHD (P < .001). Also, RCT and AT have a significant relationship (P < .001). The authors determined that the risk of RCT increased 3.45 times when patients with AHD 6-10 mm were compared with patients with AHD >10 mm. In addition, all patients with AHD < 6mm had RCT, and the risk of RCT increased 1.42 times when patients with AT > 8 mm were compared with patients with AT < 8 mm.

CONCLUSION

Acromiohumeral distance and AT measurements are practical, inexpensive, and valuable in evaluating RCT. Decreased AHD and increased AT increase the risk of RCT.

Modifiable and Nonmodifiable Risk Factors Associated with the Development of Recurrent Rotator Cuff Tears

Nonoperative and operative strategies exist to manage rotator cuff pathology. Although surgical repair is successful for most patients, others may experience retear or nonhealing of the rotator cuff. Several modifiable and nonmodifiable risk factors are associated with an increased retear rate. The literature shows consistency and agreement regarding many of these risk factors, most notably, patient age, tear size, and rotator cuff muscular atrophy, whereas others remain controversial. It is important that shoulder surgeons are familiar with modifiable and nonmodifiable risk factors associated with retear, to better advise patients and optimize their chances of success following rotator cuff repair surgery.

Does the Fatty Infiltration Influence the Re-tear Rate and Functional Outcome After Rotator Cuff Repair? A Systematic Review and Meta-analysis

Purpose

Fatty infiltration (FI) of the rotator cuff muscles occurs after rotator cuff tears (RCTs), which may affect the outcome of the repair procedure. This study aimed to determine the relationship between preoperative FI and the rate of re-tear and functional outcomes after rotator cuff repair.

Methods

Computerized databases, including PubMed, EMBASE, Web of Science, and Cochrane Library database were searched for studies published from the inception date to January 2022. Two reviewers independently screened the titles and abstracts using prespecified criteria. Articles were included if they clearly stated the effect of varying degrees of FI on the outcome after shoulder cuff repair. Comparison was performed by different degrees of FI analysis: no FI is grade 0-1, FI is grade 2 and above. Statistical analysis was performed using Review Manager 5.4.1 software.

Results

A total of 16 articles involving 1383 patients from 8 countries were included. The follow-up period ranged from 8 to 121 months. In terms of re-tear rate: patients with preoperative FI had significantly higher rates of re-tear compared with patients without FI (OR 4.60, 95% CI 2.22-9.54, p < 0.0001), supraspinatus FI VS no FI (OR 2.06, 95% CI 1.00-4.24, p = 0.05), infraspinatus FI VS no FI (OR 2.42, 95% CI 1.19-4.91, p = 0.01). In terms of functional scoring: patients without FI had higher postoperative Constant-Murley (Constant) scores than those with FI (MD - 5.06, 95% CI - 9.40 to - 0.72, p = 0.02), there was no clear evidence that preoperative FI was related to postoperative American Society of shoulder and elbow physicians scores and the University of California at Los Angeles scores and range of motion.

Conclusion

FI after RCTs significantly increases the risk of postoperative re-tear and leads to worse functional scores, especially FI of the infraspinatus muscle. However, FI does not seem to reduce postoperative range of motion.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43465-022-00807-0.

Does the critical shoulder angle influence retear and functional outcome after arthroscopic rotator cuff repair? A systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to evaluate the correlation between increased critical shoulder angle (CSA) and higher retear rates and functional outcomes after arthroscopic rotator cuff repair (ARCR).

METHODS

PubMed, Embase, Web of Science, and Cochrane Library databases published before January 2022 were comprehensively searched. Two reviewers independently reviewed the titles and abstracts using the specified criteria. Studies were included if the authors clearly described the correlation between the CSA and rotator cuff repair. Data on patient characteristics, mean CSA, retear rate, and the functional score was pooled from the selected articles. A meta-analysis was performed using Review Manager (RevMan) 5.4.1 software, 2020 (Cochrane Collaboration, Copenhagen, Denmark).

RESULTS

Eleven articles involving 1449 patients from 7 countries were included. The ages of the patients ranged from 45 to 75 years. The follow-up period ranged from 6 to 96 months. The mean CSA was greater in the retear group than in the non-retear group after ARCR (mean difference 2.73°; 95% confidence interval [CI] 0.69-4.77) (p = 0.009). Three studies evaluated the association between increased CSA and the postoperative retear rate. All three studies showed a higher postoperative retear rate in patients with an increased CSA (odds ratio 5.35; 95% CI 2.02-14.15; p = 0.0007). No association was found between CSA and Constant-Murley (Constant), the University of California at Los Angeles (UCLA), or Visual Analog Scale (VAS) scores during the follow-up period of 24-96 months (p > 0.05).

CONCLUSIONS

This systematic review and meta-analysis showed that CSA correlates highly with rotator cuff retear after ARCR. In addition, the postoperative retear rate of the rotator cuff increased with increased CSA. CSA appeared to not affect worse functional outcomes in patients after ARCR.

Transosseous repair with a cortical implant for greater tubercle cyst-related rotator cuff tear results in good clinical outcomes, but significant implant migration

PURPOSE

To evaluate whether an arthroscopic transosseous technique (ATO) with cortical implants is effective for rotator cuff tear (RCT) repair in patients with cysts of the greater tuberosity (GTC).

METHODS

Patients treated with the ATO technique between January 2013 and October 2017 were evaluated. Inclusion criteria were patients treated for both cyst-related and non-cyst-related RCTs and patients with a moderate-sized tear (1-3 cm) according to the DeOrio and Cofield classification. A total of 39 patients were separated into two groups: Group 1 (n = 16) patients with cyst-associated RCT, and Group 2 (n = 23) patients with no cyst. Implant pull-out and migration were evaluated radiologically on standard antero-posterior shoulder radiographs and rotator cuff re-tear was assessed on magnetic resonance images at the final follow-up examination. Group 1 patients were separated into two subgroups according to cyst size (cyst < 5 mm and cyst ≥ 5 mm) and subgroup analysis was performed. Clinical assessment was performed using a visual analog scale, the Constant score and Oxford shoulder score.

RESULTS

The mean follow-up time was 33.7 ± 11.7 months. The mean cyst size was 5.4 ± 1.5 mm. There was no significant difference in re-tear rates between the cystic and non-cystic groups. The mean implant migration distance was 3.0 ± 2.2 mm in patients with a RCT -related cyst and 0.7 ± 0.8 mm in those without a cyst. A statistically significant difference was found between the groups (p = 0.002). There was no statistically significant difference between the groups in respect of clinical scores. No implant failure was observed.

CONCLUSION

The ATO method performed with a cortical implant in RCTs resulted in satisfactory recovery and clinical outcomes in the short to medium term with low failure rates. While no implant failures were observed, implant migration was associated with cyst presence. Therefore, judicious use is advocated in the choice of transosseous fixation for cyst-related RCTs and patients should be informed of the possibility of implant migration.

LEVEL OF EVIDENCE

III.