Saturday, October 17, 2020

Does attempted rotator cuff repair change the risk of cuff tear arthropathy?

 Factors associated with the development of early- to mid-term cuff-tear arthropathy following arthroscopic rotator cuff repair

These authors sought to identify the factors associated with the development of cuff tear arthropathy, to evaluate the effect of arthropathy on functional outcomes, and to evaluate the incidence of cuff-tear  arthropathy 3 to 10 years after attempted arthroscopic rotator cuff repair in 312  patients with large or massive full thickness rotator cuff tears.

Cuff tear arthropathy (CTA) was defined as arthritic glenohumeral changes due to rotator cuff insufficiency.

The rate of development of CTA was 11.5% (36 of 312 patients, 13 centric and 23 eccentric arthropathy). 

CTA was more frequently associated with the poor integrity of the supraspinatus tendon, massive tears, pseudoparalysis,  re-tear, tear size, critical preoperative acromiohumeral interval and superior migration of the humeral head.

Shoulders with "mild" arthritis before surgery were three times more likely to develop CTA.

Patients with post-repair CTA had significantly worse functional outcome scores.

Comment: This study points out that shoulders with poor quality tendon, large tears, superior displacement of the humeral head and arthritis before surgery are more likely to develop CTA at three years after attempted cuff repair.

The key question that was not asked in this study is whether attempted repair affected the development of CTA. The authors could have performed such a study by stratifying shoulders by preoperative disease severity and investigating the extent to which an attempted repair was associated with the clinical outcome and the development of CTA.

For example, are shoulders with superior displacement of the humeral head and early arthritis appropriate candidates for attempted cuff repair?

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