Abstract
PurposeArthroscopic rotator cuff repair (ARCR) for relatively small rotator cuff tears (RCTs) has shown promising results; however, such surgery for larger tears often results in failure and poor clinical outcomes. One cause of failure is over-tension at the repair site that will be covered with the tendon stump. Reports on the clinical outcomes using ARCR with tension ≤ 30 N are lacking. This study aimed to evaluate ARCR outcomes and failure rates using less tension (30 N) and to assess the prognostic factors for failure.MethodsOur study group comprised of 118 patients who underwent ARCR for full-thickness RCTs with full tendon stump coverage of the footprint with a tension of ≤ 30 N, measured using a tension meter; no additional procedures, such as margin convergence or footprint medialisation, were performed. The failure rate was calculated, and the prognostic factor for failure was assessed using multivariate regression analyses.ResultsThere were seven cases of failure in the study group. Postoperatively, flexion and internal rotation ranges of motion, acromiohumeral interval, muscle strength, and clinical results improved significantly. Using multivariate regression analyses, intraoperative concomitant subscapularis tendon lesion and pre-operative infraspinatus tendon retraction, assessed using radial-sequence magnetic resonance imaging, were significantly correlated with post-ARCR failure using less tension (p = 0.030 and p = 0.031, respectively).ConclusionARCR is likely to succeed for RCTs that can be extracted using tension ≤ 30 N. However, cases with more severe subscapularis tendon lesions and those with high infraspinatus tendon retraction may show surgical failure.Level of evidenceLEVEL IV Retrospective case series
Highlights
Rotator cuff tears (RCTs), often occurring in older people, are a possible cause of shoulder pain
Flexion and internal rotation ranges of motion, acromiohumeral interval, muscle strength, and clinical results improved significantly
Kim et al reported that the tension on the repair site in one treatment group had resulted in post-arthroscopic rotator cuff repair (ARCR) failure when using significantly higher tension than that in a healed group [18]; reports concerning the results of cuff integrity and clinical outcomes using ARCR with tension ≤ 30 N are lacking
Summary
Rotator cuff tears (RCTs), often occurring in older people, are a possible cause of shoulder pain. Excellent results have been reported using ARCR for relatively small RCTs; in patients with larger tears, ARCR has Yokoya et al J EXP ORTOP (2021) 8:21 extent clinical results and failure rates could be improved using ARCR with less tension, that is, at ≤ 30 N. We aimed to evaluate the outcomes and failure rates of ARCR with tension ≤ 30 N and analyse the prognostic factors causing failure after ARCR under such conditions. The hypothesis was that repairing with a tension of less than 30 N would reduce failure after ARCR, and the larger tears including multiple tendons and the more degenerated RCTs would be the prognostic factors
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