Sunday, November 13, 2016

42% failure rate for rotator cuff repair - are the patient's genes at fault?

Identification of a genetic variant associated with rotator cuff repair healing.

These authors studied 72 patients undergoing arthroscopic rotator cuff repair for a full-thickness posterosuperior tear.  Magnetic resonance imaging studies were performed at a minimum of 1 year postoperatively (average, 2.6 years). Of 72 rotator cuff repairs 42% failed to heal (39% of small and medium-sized tears failed; 46% of large and massive tears failed) as shown in the MRI below.

42% of the patients reported a family history of rotator cuff tear. Multivariate regression analysis showed a significant association between familiality and overall healing failure.

An increased risk for the presence of a rare allele for SNP rs17583842 was present in lateral failures compared with those that healed (P = .005).

The authors concluded that individuals with a family history of rotator cuff tearing were more likely to have repair failures. 

Comment: This study shows a high rate of cuff repair failure, at least some of which may be attributed to the patient's genetics. This points to the importance of collecting a family history for patients considering cuff repair. 

It would have been of interest to know the difference in clinical outcome between the patient with healed and failed repairs.

The high rate of cuff repair failure and the significance of repair failure on clinical outcome has been the topic of many of our posts, including these: