Prediction of the Irreparability of Rotator Cuff Tears

Abstract

To determine the influence of preoperative factors on reparability of rotator cuff tears (RCTs) and yield a predictive model for predicting irreparability preoperatively. Among patients with full-thickness RCTs, the reparable group underwent arthroscopic rotator cuff repairs for reparable RCTs whereas the irreparable group underwent alternative surgical procedures for irreparable RCTs. We analyzed age, sex, chronic pseudoparalysis (CPP), mediolateral and anteroposterior tear sizes, acromiohumeral distance (AHD), tangent sign, fatty infiltration (FI) (group 1, Goutallier stage 0 or 1; and group 2, Goutallier stage 2, 3, or 4), and tendon involvement (TI) (type 1, supraspinatus; type 2, supraspinatus and subscapularis; type 3, supraspinatus and infraspinatus; and type 4, all 3 tendons). The irreparability rate was 12.5%. Between the reparable (663 patients) and irreparable (95 patients) groups, significant differences were found in age (58.8 ± 8.3years vs 65.6 ± 8.0years, P < .001); female sex (46.9% vs 63.2%, P= .014); CPP (6.5% vs 36.8%, P < .001); mediolateral tear size (23.7 ± 12.1mm vs 47.4 ± 9.1mm, P < .001); anteroposterior tear size (17.9 ± 11.5mm vs 43.4 ± 16.2mm, P < .001); AHD (9.0 ± 1.7mm vs 5.8 ± 1.6mm, P < .001); tangent sign (2.9% vs 61.1%, P < .001); group 2 FI of the subscapularis (6.9% vs 20.0%, P < .001), supraspinatus (12.1% vs 58.9%, P<.001), infraspinatus (26.8% vs 69.5%, P < .001), and teres minor (4.2% vs 10.5%, P= .008); and type 1, 2, 3, and 4 TI (88.1%, 6.2%, 5.4%, and 0.3%, respectively, vs 29.5%, 21.1%, 28.4%, and 21.1%, respectively; P < .001). Multiple logistic regression analysis showed CPP, mediolateral tear size, AHD, tangent sign, group 2 FI of the supraspinatus, and type 4 TI were significant independent predictors of irreparability, with odds ratios of 3.539 (P= .007), 1.087 (P < .001), 0.624 (P<.001), 6.141 (P < .001), 2.233 (P= .034), and 12.350 (P= .016), respectively. These factors yielded a predictive model for irreparability as follows: Logit P= 1.264× CPP+ 0.084× Mediolateral tear size - 0.472× AHD+ 0.804× Group 2 FI of supraspinatus+ 1.815× Tangent sign+ 2.514× Type 4 TI - 3.460. The irreparability of RCTs is strongly associated with CPP, mediolateral tear size, AHD, tangent sign, group 2 FI of the supraspinatus, and type 4TI and can be preoperatively calculated using the predictive equation. Level III, retrospective comparative study.