Preoperative radiographic risk factors for incomplete arthroscopic supraspinatus tendon repair in massive rotator cuff tears

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Purpose The purposes of this study were to: determine if preoperative imaging findings thought to be characteristic of massive RC tears were associated with the need for advanced mobilization techniques (interval slides), and/or the use of a load sharing rip stop (LSRS) repair construct, and to determine the extent to which these imaging findings predicted the likelihood of an incomplete arthroscopic repair. Methods Eighty-six consecutive patients that underwent arthroscopic repair for massive RC tears performed by a single surgeon were retrospectively evaluated. Previously proposed radiographic risk factors for irreparability (acromiohumeral distances, tangent sign and the Goutallier stage of fatty infiltration for the supraspinatus) were analyzed. Associations between preoperative imaging characteristics and intraoperative results of RC surgery were determined using binary logistic regressions and Fisher's exact tests. The inter-observer reliability of imaging characteristics was determined using intraclass correlation coefficients (ICC). Results Seventy-six massive RC tears were fully reparable (88%). In the case of 10 RC tears (12%), a complete repair was not obtained. Inability to obtain a complete repair of the supraspinatus was associated with a positive tangent sign (30% irreparable) versus a negative tangent sign (6.3% irreparable, OR = 6.3, P = 0.0102) and with Goutallier grade 3–4 fatty infiltration of the supraspinatus (42.9% irreparable) versus grade 0–2 fatty infiltration (5.7% irreparable, OR = 11.8, P = 0.001). No associations were found between preoperative imaging characteristics and use of interval slides or LSRS. Inter-observer reliability was moderate (ICC 0.75–0.90) for the tangent sign (ICC = 0.78) and high-grade (Goutallier 3–4) fatty infiltration of the supraspinatus (ICC = 0.74). Conclusions A positive tangent sign and/or high-grade fatty infiltration (Goutallier 3–4) were risk factors for incomplete RC tear repair. However, these were not completely predictive of reparability, as the majority of massive RC tears with these imaging characteristics were still fully reparable.