Risk factors for postoperative retears in patients with small to medium tears following arthroscopic rotator cuff repair

Abstract

Background

The retear rate after arthroscopic rotator cuff repair for small/medium tears is considered lower than that for large/massive tears. However, few studies have reported risk factors for small/medium retears. Therefore, this study investigated the risk factors for small/medium retears following arthroscopic rotator cuff repair.

Methods

The retrospective study involved 129 patients who underwent arthroscopic rotator cuff repair for small/medium rotator cuff tears at our hospital between January 2018 and June 2021. Clinical evaluations at preoperative and final follow-up were conducted using the criteria of University of California, Los Angeles score and Constant Shoulder score, and the achievement of minimal clinically important difference of those scores were recorded. Physical examination findings, imaging findings (stump classification and Goutallier classification), suturing methods, and past medical history including smoking history and diabetes were investigated to assess their relevance to clinical outcomes and retear. At the final postoperative follow-up, structural outcome was evaluated using magnetic resonance images, and Sugaya classification type 4 or 5 was defined as a retear.

Results

In total, 76 male and 53 female patients with a mean age of 64.2 ± 9.1 years were enrolled. The shortest follow-up period was 12 months postoperatively (range, 12–44 months; mean, 22.09 ± 7.27 months). All clinical scores of 129 patients showed significant postoperative improvement (P < .001). Based on the Cofield classification, 44 patients had small tears compared with 85 patients who had medium tears, whereas 15 (11.6%) patients experienced retears. Multivariate analysis of retear-related factors revealed that symptom duration, absence of traumatic episode, tendon edge status (stump classification), Goutallier classification of the supraspinatus (stages ≥2), and absence of the long head of the biceps tendon during surgery were significant risk factors for retears (P < .01). The correlation analysis between symptom duration and other factors showed a significant association with traumatic absence only (P < .0001).

Conclusion

This study showed that after arthroscopic rotator cuff repair for small/medium rotator cuff tears, patients are exposed to a substantial number of risk factors of postoperative retears of which symptom duration and absence of traumatic episodes were the only inter-related factors.