Midterm Functional Outcomes After Retear of an Arthroscopic Rotator Cuff Repair: A Propensity Score–Matched Comparative Study

Abstract

Background:Studies are still limited on the isolated effect of retear after arthroscopic rotator cuff repair (ARCR) on functional outcomes after the midterm period.Purpose:To assess the effect of retear at midterm follow-up after ARCR and to identify factors associated with the need for revision surgery.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review was conducted on patients who underwent ARCR between 2014 and 2018, with a minimum 5-year follow-up. The structural integrity was evaluated using magnetic resonance imaging. After propensity score matching, 65 patients for the retear group and 65 for the healed group were included. Functional outcomes, including visual analog scale for pain and function (PVAS and FVAS) and American Shoulder and Elbow Surgeons (ASES) score, were compared between the groups at 1 year and final follow-up. Multivariate analysis was conducted on the retear group to identify factors associated with the final ASES score.Results:The mean ± SD follow-up period was 6.9 ± 1.4 years. All outcomes at the final follow-up improved as compared with the preoperative status, regardless of retear (all P < .001). In the retear group, PVAS at the final follow-up showed deterioration when compared with postoperative 1 year ( P = .044). While there were no significant differences in all outcomes at 1 year postoperatively between the groups (all P > .05), the retear group demonstrated significantly worse outcomes than the healed group in scores on the PVAS (2.5 ± 1.5 vs 1.9 ± 1.5; P = .011), FVAS (7.3 ± 1.4 vs 7.8 ± 1.3; P = .020), and ASES (73.2 ± 12.7 vs 79.9 ± 15.4; P = .008) at the final follow-up. The revision rate in the retear group was 12.8%, and multivariate analysis showed that larger anteroposterior retear size ( P = .017) and retear of the subscapularis ( P = .047) were negatively associated with the final ASES score.Conclusion:Functional outcomes after ARCR improved during midterm follow-up, regardless of retear. While the effect of retear itself on functional outcomes was minimal in the short term, it became more pronounced after the midterm period. A retear involving the subscapularis or with a larger anteroposterior size was associated with a poorer functional outcome.