Friday, December 21, 2012

Intraoperative Determinants of Rotator Cuff Repair Integrity

Intraoperative Determinants of Rotator Cuff Repair Integrity

This is an individual surgeon experience with 500 arthroscopic cuff repairs evaluated for integrity by ultrasound at 6 months. The best predictor of cuff repair integrity at followup was the size of the tear being repaired as shown in the chart below. Patient age was the next best predictor of integrity. Tendon quality and mobility and repair quality were much less influential on the result.
This study provides valuable information that we can use in our preoperative discussions with our patients, weighing out the different possible approaches for management of cuff tears.  Important to remember that 6 month is early in the recovery of cuff repairs - it is likely that the failure rate would be higher with longer periods of followup.

It would have been more informative if the authors had included clinical outcomes along with their integrity data so the relative influence of integrity on clinical outcome could be determined.
It would have also been of interest to know whether the acuity of the tear had in influence on the outcome (i.e. is the prognosis for acute large tears the same as for chronic large tears?).

Nevertheless, the authors are commended on a robust study design and analysis: "During the study period (between January 2006 and February 2009), 722 rotator cuff repairs were performed. Of these, 667 repairs were performed using the Opus Magnum knotless anchor. A total of 167 patients were excluded on the basis of the exclusion criteria: 14 patients were excluded because of previous shoulder surgery or redo of rotator cuff repair, 22 were excluded for incomplete or partial cuff repairs, 38 were excluded for moderate to severe osteoarthritis of the shoulder, 10 were excluded for isolated subscapularis repair, 1 patient was excluded because of a greater tuberosity fracture, and 82 patients were excluded because they were lost to follow-up or no ultrasound was performed at 6 months. The remaining 500 patients form the study cohort."

As we've suggested in a previous post, so much of what influences the outcome of cuff surgery can be determined without worrying about fatty infiltration on MRI.

We also note that these 6 month retear rates are virtually identical to those reported with other methods of repair, so that the tear size rather than the repair method may be the key determinant of the integrity outcome.

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