Risk factors for symptomatic retears after arthroscopic repair of full-thickness rotator cuff tears
These authors analyzed consecutive patients having full-thickness tears of the supraspinatus repaired arthroscopically.
They identified symptomatic re-tears, defined as "Sugaya type IV and V on magnetic resonance imaging that were associated with intensive pain and/or functional impairment."
These patients were compared to those without symptomatic re-tears with respect to potential risk factors for symptomatic re-tears.
Corticosteroid injection (CSI) was defined when the patient received 1 or more preoperative injections.
Depression was defined when the patient had a medical diagnosis of depression at the time of the surgical assessment and/or was receiving antidepressant treatment because of depression.
The symptomatic retear rate was 9.5% in 158 patients. Patients in the symptomatic retear group were more likely to be smoking, to have massive tears, a short acromiohumeral distance, and moderate to severe fatty infiltration.
On multivariate analysis, corticosteroid injections were associated with a 7 fold increase and depression was associated with an 8 fold increase in symptomatic re-tear risk.
Comment: It is well recognized that a high percentage of rotator cuff repair attempts fail to durably re-establish a secure connection between the torn tendon and bone, even for repairs of tears confined to the supraspinatus. It is also recognized that a high percentage of anatomically failed repair attempts yield improved postoperative shoulder comfort and function in spite of having a Sugaya 4 or 5 re-tear.
Patients with re-tears but without substantial symptoms would have been assigned to the "control" group in this study: asymptomatic patients were not routinely examined by MRI. Thus the "symptomatic retear rate" of 9.5% (15 of 158 patients) in this study is likely to be substantially lower than the actual anatomic failure rate. Only 25 postoperative MRIs were obtained in 158 patients.
Most of the findings of this study are consistent with prior publications regarding the risks factors for rotator cuff repair failure. The observation that depression was associated with post operative intensive pain and/or functional impairment and Sugaya types IV and V on magnetic resonance imaging may be due to the fact that patients with depression are more likely to have "intensive pain and/or functional impairment" after surgery and thus to meet the criteria for a "symptomatic re-tear".
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