Deteriorated Quality and Media Retraction of Tendon Following Acute Traumatic Rotator Cuff Tear are Predictors of Retear After Arthroscopic Repair.

Abstract

Purpose: This study aimed 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 following a slip or fall. Gross tendon quality was assessed using arthroscopic imaging and categorized as none, mild, or advanced, which corresponded to grades 0, 1, and 2, respectively. RC retear was assessed using magnetic resonance imaging (MRI) 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% (33/121). RC retears were significantly associated with medial supraspinatus retraction (P = 0.015), atrophy with fatty infiltration (P = 0.010) on MRI, tendon deterioration (P < 0.001), and anterior rotator cable rupture (P = 0.034) observed during arthroscopy. In multivariable analysis, advanced tendon deterioration (grade 1 vs. 0: odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-1.3, P = 0.117; grade 2 vs. 0: OR 6.3, 95% CI 1.9-21.2, P = 0.003) and the absence of initial pseudoparesis (OR 0.1, 95% CI 0.02-1.0, P = 0.045) were identified as significant predictors of retear. Additionally, supraspinatus medial retraction (OR 1.5, 95% CI 1.0-2.2, P = 0.056) was identified as a potential predictor of retear. The final function visual analog scale was significantly lower in the RC retear group than in the intact group (7.1 ± 1.8 vs. 8.0 ± 1.2, P = 0.013), 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, along with supraspinatus medial retraction and the absence of initial pseudoparesis, were predictors of retear in the repair of traumatic RC tears. Intraoperative assessment of tendon quality would be important for predicting surgical outcomes in traumatic RC tear repair.

Level of evidence: Level IV, Retrospective case series.