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Background No evaluation has been done on the relationship of the acromion–greater tuberosity impingement index (ATI) with retear after arthroscopic rotator cuff repair (ARCR). Our purpose was to evaluate whether a higher ATI is associated with retear after ARCR. Methods 132 patients received ARCR and underwent MRI scan at a one year follow-up to assess tendon healing, and the findings were graded no retear (NR), partial-thickness retear (PR) or full-thickness retear (FR). The ATI, the critical shoulder angle (CSA), acromion index (AI) and lateral acromial angle (LAA) were measured with postoperative radiographs. Functional scores were obtained preoperatively and at a one year follow-up. Results Postoperative Constant scores and ASES scores were significantly different between groups with inferior outcomes in the FR group ( p < 0.05 for all). The UCLA score was significantly better in the NR group compared with the PR and FR groups ( p < 0.05), and in the PR group compared with the FR group ( p < 0.05). For ATI and CSA, the values of the PR and FR groups were larger than the NR group ( p < 0.05 for all), but there were no significant differences between the PR and FR groups ( p > 0.05 for all). No significant differences were observed with regard to the AI and LAA ( p > 0.05, respectively). The repair integrity was positively related to the ATI (0.304, p < 0.05) and CSA (0.252, p < 0.05), but not related to the AI or LAA ( p > 0.05 for both). ATI was not related to any functional scores ( p > 0.05 for all). Conclusion This study revealed that the ATI was positively related to rotator cuff retear. Patients with retears had significantly greater ATIs after ARCR. Level of Evidence: III, case–control study.

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