Risk Factors For Retear Research Articles

Socioeconomic and Other Risk Factors for Retear after Arthroscopic Surgery for Nontraumatic Rotator Cuff Tear.

Background and Objectives: Few studies have investigated the socioeconomic factors associated with retear after rotator cuff repair. This study aimed to identify the risk factors, including socioeconomic factors, for rotator cuff retear in patients who underwent arthroscopic rotator cuff repair. Materials and Methods: This retrospective study included 723 patients diagnosed with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair from March 2010 to March 2021. The outcome variable was rotator cuff retear observed on postoperative magnetic resonance imaging or ultrasonography. Sex, age, obesity, diabetes, symptom duration, and tear size were the independent variables. Socioeconomic variables included occupation, educational level, type of medical insurance, and area of residence. We compared patients with and without retear and estimated the effects of the independent factors on retear risk. Results: The mean age of the patients, symptom duration, and tear size were 62.4 ± 8.0 years, 1.8 ± 1.7 years, and 21.8 ± 12.5 mm, respectively. The age, type of medical insurance, diabetes, tear size, and symptom duration differed significantly between patients with and without retearing (p < 0.05). Age, occupation, type of medical insurance, diabetes, initial tear size, and symptom duration significantly affected the risk of retear. Patients who performed manual labor had a significantly higher retear rate (p = 0.005; OR, 1.95; 95% CI, 1.23-3.11). The highest retear risk was seen in patients with Medicaid insurance (p < 0.001; OR, 4.34; 95% CI, 2.09-9.02). Conclusions: Age, initial tear size, and symptom duration significantly affect retear risk after arthroscopic rotator cuff repair. Occupation and type of medical insurance were also risk factors for retear. Socioeconomically vulnerable patients may be at a greater risk of retear. Proactive efforts are required to expand early access to medical care.

Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review.

Retear after arthroscopic rotator cuff repair (ARCR) consistently challenges medical staff and patients, and the incidence of retear after surgery is 10%-94%. The purpose of this study was to identify the risk factors that cause retear after ARCR and provide theoretical guidance for clinical intervention to reduce the occurrence of postoperative rotator cuff retear. The protocol for this meta-analysis was registered with PROSPERO (CRD42021225088). PubMed, Web of Science, and Embase were searched for observational studies on risk factors for rotator cuff retear after arthroscopic repair. Meta-analytical methods were used to determine the odds ratio or weighted mean difference of potential risk factors related to postoperative rotator cuff retear. Stata 15.1 was used to quantitatively evaluate the publication bias of the statistical results. Fourteen studies from 6 countries with a total of 5693 patients were included. The meta-analysis revealed that the risk factors for retear after rotator cuff repair were age, body mass index, diabetes, subscapularis and infraspinatus fatty infiltration, symptom duration, bone mineral density, tear length, tear width, tear size area, amount of retraction, critical shoulder angle, acromiohumeral interval, distance from the musculotendinous junction to the glenoid, operative duration, biceps procedure, and postoperative University of California Los Angeles shoulder score. These findings can help clinical medical staff identify patients who are prone to retear early after arthroscopic repair and develop targeted prevention and treatment strategies for modifiable risk factors, which are of great significance for reducing the occurrence of rotator cuff retear after ARCR.

Is residual tendon a predictor of outcome following arthroscopic rotator cuff repair? A preliminary outlook at short-term follow-up

Multiple factors including muscle atrophy, fatty infiltration, smoking, advanced patient age, and increasing tear size have been identified as risk factors for retear after rotator cuff repair. However, little is known about what effect the length of the residual rotator cuff tendon has on the success of repair and patient outcomes. This study included 64 patients. Patients were stratified based on a residual tendon length of greater than 15 mm (group 1, residual tendon)or 15 mm or less (group 2, no residual tendon). Rotator cuff tendon integrity was then evaluated using ultrasound imaging at 6 months. Outcome measures includedthe Single Assessment Numeric Evaluation score, visual analog scale score, EQ5D Index score, Global Rating of Change score, and Penn Shoulder Score. No differences were found between groups regarding demographic data or repair configuration. Assessment of tendon healing demonstrated an increased rate of tendons that had "not healed" in group 2 (19.3% [n = 5] vs. 13.2% [n = 5]), but this difference was not statistically significant (P = .55). Functional outcome scores improved significantly from preoperatively to final follow-up in both groups and displayed no differences at 6-month follow-up. A smaller residual tendon length was not a negative predictor of clinical outcomes following arthroscopic rotator cuff repair in patients with short-term follow-up. Although there was a trend towarda decreased rate of healing in patients with smaller residual tendons, this was not significant.

Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears.

Background:Few studies have compared the clinical and radiological characteristics and outcomes in isolated subscapularis (SSC) and combined anterosuperior (AS) rotator cuff tears (RCTs). Furthermore, risk factors for retear after SSC repair and the effect of preoperative fatty degeneration require further evaluation.Purpose:To compare the functional and radiological outcomes of isolated SSC with combined AS RCTs after arthroscopic repair and to determine the risk factors for SSC retear in these 2 groups.Study Design:Cohort study; Level of evidence, 3.Methods:Data from 30 patients in the isolated SSC group were compared with data from 110 patients in the combined AS group. All patients underwent primary arthroscopic rotator cuff repair between 2010 and 2016. Clinical outcomes were assessed through use of the visual analog scale for pain, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test at a mean follow-up of 26.7 months (range, 24-96 months). SSC tendon integrity was examined via magnetic resonance imaging, computed tomography arthrogram, or ultrasonography at least 1 year after surgery.Results:The isolated SSC group had a greater proportion of males and the patients were younger compared with the combined AS group (both P < .050). The incidence of trauma was high but not significantly different between groups (56.7% vs 40.9%; P = .180). Clinical outcome measures and radiological outcomes in terms of retear were not statistically different between both groups (16.7% vs 8/5%; P = .337). The optimal cutoff values for the risk of SSC tendon retear in both groups were 19-mm retraction and 16-mm superoinferior dimension (P = .048). Unfavorable preoperative fatty degeneration of the SSC muscle (grades 3 and 4) was a significant risk factor for retear (odds ratio, 9.8; P < .001).Conclusion:Isolated SSC and combined AS RCTs were comparable except for patient age and sex; both had a high incidence of traumatic history. The current data suggest that the risk factors for retear after SSC repair in RCTs involving the SSC were tear size greater than 19 mm of retraction and unfavorable fatty degeneration (grade 3 or higher) of the SSC muscle.

Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time

To analyze failure rate in 2-year increments to determine if graft choice changed over time and graft failure rate. A prospective 2002-2008 database was used to identify risk factors for anterior cruciate ligament (ACL) retear. Subjects who had primary ACL retear with no history of contralateral surgery and 2-year follow-up were included. Subjects who underwent a multiligament reconstruction were excluded. Graft type, age, sex, smoking status, body mass index, Marx activity level at index surgery, medial and lateral meniscus status at time of ACL retear, sport played after ACL reconstruction, and clinical site were evaluated. Analysis was repeated using 2002-2003 (early) and 2007-2008 (late) 2-year databases. Analysis of variance with post hoc analysis was performed to detect significant differences in age and Marx score by graft type over time. Two-year follow-up for graft failure was obtained on 2,497 of 2,692 (93%) subjects. There were 112 of 2,497 (4.5%) ACL retears identified at 2-year follow-up. The only predictor that changed between early/late periods was allograft use. Allograft odds ratio decreased from 13.1 to 9.5 (P < .01). Allografts were used in older patients (31-40years) and with lower Marx scores (10-8) from early to late periods. The mean age of subjects who received bone-patellar tendon-bone autografts did not significantly change over time (22.8-23.5). The mean age of subjects who received hamstring autografts fell (27.9-25.5). The mean age of subjects who received allografts rose significantly (31.3-39.8, P < .01). The mean Marx score of subjects who received bone-patellar tendon-bone and hamstring autografts did not significantly change over time. The mean Marx score of subjects who received allografts decreased significantly (P < .01). After early recognition, allograft use in young active patients was a risk factor for retear; graft choice by surgeons changed in the late period to use of allografts in older and less-active patients, which correlated with a significant decrease in retear risk. Level III, case control study.

Hyperlipidemia increases the risk of retear after arthroscopic rotator cuff repair

Hyperlipidemia (HL) has been identified as a risk factor for rotator cuff tear, but no studies have evaluated its effects on healing. The purpose of this study was to evaluate the effect of HL and statin use on rotator cuff healing after arthroscopic repair. This was a retrospective review of 85 patients (86 shoulders) who underwent arthroscopic rotator cuff repair with postoperative ultrasound evaluation. Ultrasound findings were graded no retear, partial-thickness retear (PT), or full-thickness retear (FT). Average age was 62.1 years (45.3-74.3 years). On ultrasound evaluation, 65 shoulders (75.5%) had no retear, 14 (16.3%) had PT, and 7 (8.1%) had FT. There was no significant difference in retear rate by age, technique, or tissue quality. There were 33 patients (38.8%) who had the diagnosis of HL, and all were taking a statin medication. Compared with patients without HL, patients with HL had significantly higher rates of FT (18.1% vs. 1.9%; P < .001) and PT (27.2% vs. 9.4%; P < .001). The total retear rate (PT and FT) for HL patients was significantly higher at 45.5% (15/33) compared with the patients without HL at 11.3% (6/53), with an odds ratio of 6.5 (P < .001). There was no difference in retear rate by dosage or type of statin mediation. After arthroscopic rotator cuff repair, HL was a risk factor for retear. Further investigation is warranted on this topic, and these results may help in managing expectations after surgery.

Paper #27 - Correlation of clinical outcomes of retear and tear progression after arthroscopic rotator cuff repair

Background: Rotator cuff retear rate after arthroscopic cuff repair is still high despite advanced arthroscopic techniques and instrument evolution. Even if a retear occurs after rotator cuff repair, improvement in shoulder function is generally maintained, and it is known that rotator cuff integrity does not correlate with clinical outcomes. However, recent studies reported that clinical results of patients with a cuff retear are worse than those with a healed cuff. Therefore, functional outcomes of patients with rotator cuff retear are still on debate. This study evaluated factors related to clinical outcomes of rotator cuff retear after arthroscopic rotator cuff repair focusing on the importance of preoperative and postoperative changes of tear size. Materials and Methods: Four hundred and forty-two patients with full-thickness rotator cuff tear who underwent arthroscopic rotator cuff repair were included in this study. Patients who were possible to cover footprint completely, able to follow up over 2 years, and conducted postoperative MRI at 6 months for tendon integrity were included. The size of tear was measured on the oblique coronal and sagittal images of both preoperative and postoperative MRI. Intact tendon was defined as sufficient thickness of the repaired tendon showing continuity and a homogeneous low-intensity signal in the substance of cuff. Retear was defined as the repaired tendon showing complete discontinuity from footprint. Pain was measured by using VAS score, range of motion was recorded and functional outcomes were measured with ASES and Constant scores. Clinical outcomes were compared between patients with retears and intact cuff. Factors may affect clinical outcome such as preoperative tear size, changes of tear size and retear patterns were evaluated. Results: There were 233 males and 209 females with a mean age of 55 years (range; 46-75 years). Average follow-up period was 33 months (range 24-43 months). Fifty-eight patients (13.1%) had a retear confirmed by postoperative MRI. Patients with a healed cuff showed better shoulder functions than the patients with a retorn cuff (ASES; healed patients, 92.6 ± 9.5 and retear patients, 87.6 ± 12.4, P = .008). 1). Effect of preoperative rotator cuff tear size: In the patients with a preoperative large to massive size, patients with retear showed significant difference in functional outcomes (ASES: 86.5 ± 12.4 and Constant score: 88.7 ± 8.0) when compared with patients with a healed rotator cuff (ASES: 76.9 ± 9.7, P = .02 and 76.9 ± 11.7, P = .001). However, in patients with preoperative small and medium-sized tears, clinical outcomes were not significantly different irrespective of the status of healing of the cuff (ASES: healed cuff, 93.9 ± 7.8 and cuff retear, 93.8 ± 9.2 (P = .37), Constant score: healed cuff, 90.0 ± 11.7 and cuff retear, 91.5 ± 8.5 (P = .47)). 2). Comparative size of retear: Patients with smaller size of retear than the preoperative tear size (n = 28) showed significantly better functional outcomes and muscle strength recovery (Constant score: 90.5 ± 8.8) than those with equal or larger size of retear after surgery (n = 30) (Constant score: 83.7 ± 11.7, P = .025). 3). Retear pattern: Postoperative tear either at the footprint or at the musculotendinous junction did not influence the functional outcomes. 4). Risk factors for retear: Fatty degeneration more than grade 3 (odds ratio = 2.74, (CI: 1.19-6.36), P = .018) and preoperative large to massive rotator cuff tears (odds ratio = 2.2 (CI: 1.17-4.15), P = .015) were preoperatively affecting factors which were significant related to retear after surgery. Age at surgery, sex, symptom duration, arm dominance and associated pathology had no significant effect on the outcome of surgery. Conclusion: Preoperative large to massive rotator cuff tears, and fatty degeneration more than grade 3 are important contributing factors for retear after arthroscopic rotator cuff repair. Patients with preoperative small to medium sized tears had satisfactory clinical outcomes regardless of postoperative tendon integrity. However, in patients with a preoperative large to massive tear who develop retear, the functional outcomes are poorer than patients with a healed cuff. The patients with an equal or larger retorn tendon than preoperative size showed poorer Constant score and muscle strength regardless of preoperative sizes of tear. Therefore, surgeons should take more efforts and employ techniques to reduce the size of retear even if retear occurs.

Critical period and risk factors for retear following arthroscopic repair of the rotator cuff.

The incidence of retear following rotator cuff repair remains a major concern, and the cause and timing of retear remain unclear. The aim of this study was to prospectively investigate the timing of retears following rotator cuff repair at multiple time intervals. The hypothesis was that the 'critical period' for retears extends beyond the first three post-operative months. The authors prospectively studied 206 shoulders that underwent arthroscopic double-row (without suture bridge) suture anchor repair for rotator cuff tears. Patients were recalled to three follow-up visits at the following post-operative time intervals: 3, 6, and 12months or longer. Ultrasonography was performed at each visit, and Constant score was collected during the last visit. A total of 176 shoulders attended all required follow-up visits with mean age 56.0years. Ultrasonography revealed retears in 16 shoulders (9.1%) at 3months, in 6 shoulders (3.4%) at 6months, and in 5 others (2.8%) at the last follow-up, while it confirmed intact rotator cuffs in 149 shoulders (84.7%) at the last follow-up (median 35.5; range 12-61). The incidence of retears was significantly associated with tear size (p=0.001) and tendon degeneration (p=0.003). The 'critical period' for healing following rotator cuff repair, during which risks of retears are high, extends to the first 6months. The risk of retear is greatest for massive 3-tendon tears, which may require longer periods of protection. The clinical relevance of this study is the identification of patients at risk of retear and the adjustment of their rehabilitation strategy and time for return to work. III.

Risk Factors for Retear After Arthroscopic Repair of Full-Thickness Rotator Cuff Tears Using the Suture Bridge Technique: Classification System

To identify factors that predict retears after arthroscopic repair of full-thickness rotator cuff tears. Factors included age, sex, diabetes, smoking, symptom duration (group I, <12months; group II, ≥12months), tear size according to the Kim classification (group I, A and B; group II, C; group III, D), tendon involvement (group I, supraspinatus; group II, supraspinatus and subscapularis; group III, supraspinatus and infraspinatus; group IV, all 3 tendons), and degree of fatty degeneration of the supraspinatus and infraspinatus (group I, Goutallier stages 1 and 2 for each tendon; group II, Goutallier stages 3 and 4 for each tendon). Two hundred eighty-two patients underwent arthroscopic repairs of full-thickness rotator cuff tears. The overall retear rate was 13.1%. Age, sex, diabetes, smoking, and degree of fatty degeneration of the supraspinatus and infraspinatus did not affect retear rates. However, symptom duration (P= .006), Kim classification (P < .001), and tendon involvement (P < .001) did affect retear rates. The retear rates were 8.5% (14 of 165 patients) and 19.7% (23 of 117) in symptom duration groups I and II, respectively; 8.0% (13 of 163), 15.2% (16 of 105), and 57.1% (8 of 14) in Kim classification groups I, II, and III, respectively; and 6.6% (11 of 167), 22.2% (18 of 81), 10.0% (2 of 20), and 42.9% (6 of 14) in tendon involvement groups I, II, III, and IV, respectively. In the multiple logistic regression analysis, the respective odds ratios of symptom duration group II, Kim classification group III, tendon involvement group II, and tendon involvement group IV were 2.853 (P= .011), 18.108 (P= .001), 4.184 (P=.001), and 5.727 (P= .021), respectively. To preoperatively predict retears after arthroscopic repair of full-thickness rotator cuff tears, the duration of symptoms before surgery, tear size, and tendon involvement can be used. In addition, regarding tear size, the Kim classification can be used more effectively than the modified DeOrio and Cofield classification. Level IV, prognostic case series.