Tuesday, April 29, 2014

High rate of retears of rotator cuff repair: what factors are associated with failure of repair?

Factors Predicting Rotator Cuff Retears: An Analysis of 1000 Consecutive Rotator Cuff Repairs

As shown in yesterday's post, failure of rotator cuff repair to provide a durable reattachment of the torn tendon to bone is common.

These authors sought to determine which preoperative intraoperative factors were associated with retears of arthroscopic rotator cuff repairs.

They retrospectively evaluated 1000 consecutive patients who had undergone a primary rotator cuff repair by a single surgeon using an arthroscopic inverted-mattress knotless technique and who had undergone an ultrasound evaluation 6 months after surgery to assess repair integrity.
Retears occurred in 27% of full-thickness tears for an annualized retear rate of 54% per year.

The best independent associations of retears were various measures of tear size:
anteroposterior tear length
tear size area 
mediolateral tear length and
tear thickness.

Increased age at surgery and operative time were also associated with increased rates of retear - both of these may also be associated with increased tear size.

Comment: While the authors attempted to develop a predictive model, they did not prospectively test this model on a new set of patients, so the model is yet to be validated.
Nevertheless, this  article again points to the high retear rate after cuff repair, especially of larger tears in older individuals. It does not provide clinical information on how these patients fared in comparison to those with intact repairs. In any event, these data indicate that surgeons may want to be thoughtful about which shoulders merit repair along with the required period of post-operative protection. In our practice patients with large, chronic cuff tears are presented with the option of a smooth and move procedure, rather than a cuff repair.


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