Deteriorated Quality and Medial Retraction of Tendon After Acute Traumatic Rotator Cuff Tear Are Predictors of Retear After Arthroscopic Repair

Abstract

Purpose

To investigate the structural outcomes of arthroscopic repair of traumatic rotator cuff (RC) tears and analyze the factors related to retears, focusing on tendon quality observed using arthroscopy.

Methods

This retrospective study included patients who had undergone arthroscopic repair of traumatic full-thickness RC tears between 2014 and 2021. Traumatic RC tears were defined as the sudden onset or worsening of shoulder pain or function within 3 years after a slip or fall. Gross tendon quality was assessed using arthroscopic imaging and categorized as none (grade 0), mild (grade 1), or advanced (grade 2). RC retear was assessed using magnetic resonance imaging at 6 months and clinically evaluated at least 1 year after surgery.

Results

A total of 121 patients were included in the study, and the RC retear rate was 27.3% (33 of 121). RC retears were significantly associated with supraspinatus (SSP) medial retraction (P = .015) and atrophy with fatty infiltration (P = .010) on magnetic resonance imaging, as well as tendon deterioration (P < .001) and anterior rotator cable rupture (P = .034) observed during arthroscopy. On multivariable analysis, advanced tendon deterioration (grade 1 vs grade 0: odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-1.3, P = .117; grade 2 vs grade 0: OR, 6.3; 95% CI, 1.9-21.2; P = .003) and the absence of initial pseudoparesis (OR, 0.1; 95% CI, 0.02-1.0; P = .045) were identified as significant predictors of retear. Additionally, SSP medial retraction (OR, 1.5; 95% CI, 1.0-2.2; P = .056) was identified as a potential predictor of retear. The final visual analog scale score for function was significantly lower in the RC retear group than in the intact group (7.1 ± 1.8 vs 8.0 ± 1.2, P = .013), whereas other shoulder function parameters were similar between the groups. Final shoulder function was not significantly affected by tendon quality.

Conclusions

Gross tendon quality, as assessed during arthroscopy, and SSP medial retraction, as well as the absence of initial pseudoparesis, were predictors of retear after the repair of traumatic RC tears. Intraoperative assessment of tendon quality is important for predicting surgical outcomes of traumatic RC tear repair.

Level of Evidence

Level IV, retrospective case series.