What cuff tears are irreparable?

Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: a retrospective cohort study

These authors sought to identify the preoperative prognostic factors associated with structural integrity after repair of medium-sized and larger rotator cuff tears and to determine the cutoff values using receiver operating characteristic curve analysis. The study included 180 patients with medium-sized and larger rotator cuff tears. Each had a minimum 2-year postoperative follow-up by magnetic resonance imaging. 

The extent of retraction was measured by the straight line distance between the medial margin of the footprint of the supraspinatus and the medial margin of the retracted cuff on oblique coronal T2-weighted images.  The supraspinatus  occupation ratio was measured as shown in this figure

Retears occurred in 28 of the 180 patients (15.6%).  In the multivariate analysis, body mass index, diabetes, dyslipidemia, extent of retraction, delamination, distance from musculotendinous junction to face of glenoid, occupation ratio, fatty infiltration of infraspinatus, and acromiohumeral interval were significant risk factors. The extent of retraction (22.2 mm) and the occupation ratio (53.5%) showed highly accurate cutoff values for predicting retear.

Comment: The goal of rotator cuff repair is to durably re-establish the integrity of the cuff tendon insertion to the humeral tuberosity. It is a costly procedure that requires a substantial period of 'downtime' for recovery and rehabilitation. It should be offered to patients with cuff tears that are likely to achieve durable cuff integrity as a result of the repair. This study provides some guidelines for identifying those patients in whom cuff repair is likely to fail.

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