Anteroposterior tear size, age, hospital, and case number are important predictors of repair integrity: an analysis of 1962 consecutive arthroscopic single-row rotator cuff repairs

Duong, Julian; Lam, Patrick H.; Murrell, George A. C.

doi:10.1016/j.jse.2020.09.038

Cited by 25 publications

(26 citation statements)

References 32 publications

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“…The predictors of retear have been the focus of several large cohort studies. The majority of studies support the hypothesis that tear size is the most important predictor of retear 2-7,19-21 , followed by advanced age 5,7,22 . Other suggested factors include case number (a proxy measure for surgeon experience), tear thickness, and hospital type 5,22 .…”

Section: Discussionmentioning

confidence: 84%

“…The majority of studies support the hypothesis that tear size is the most important predictor of retear 2-7,19-21 , followed by advanced age 5,7,22 . Other suggested factors include case number (a proxy measure for surgeon experience), tear thickness, and hospital type 5,22 . However, all of the aforementioned studies failed to include examiner-assessed postoperative range of motion as a variable for analysis.…”

Section: Discussionmentioning

confidence: 84%

“…R etear remains the most common complication of a rotator cuff repair 1 . Previous studies have identified several factors as independent predictors of retear, specifically, larger tear size, patient age, less surgeon experience, public hospital type, and full-thickness tears [2][3][4][5][6][7] .A reduction in shoulder range of motion following surgery, particularly at 6 weeks, is the second-most-common complication of rotator cuff repair surgery 8 and coincides with increasing pain, which is often interpreted by patients as a failure of the repair 9 . Some surgeons recommend secondary capsular release surgery and/or manipulation under anesthesia to treat postoperative stiffness 10 .…”

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confidence: 99%

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Tear Size and Stiffness Are Important Predictors of Retear

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Background: This study aimed to identify whether early postoperative shoulder stiffness is associated with improved healing following rotator cuff repair, and if so, how this factor might interact with other factors known to affect rotator cuff repair integrity.Methods: We conducted a retrospective analysis of prospectively collected data from 1,526 primary arthroscopic rotator cuff repairs. Six-week range of motion was assessed to determine shoulder stiffness, and repair integrity was evaluated at 6 months by ultrasound. Multiple logistic regression analysis was used to identify variables that affected retear, and receiver operating characteristic (ROC) curve analysis was used to evaluate predictive thresholds for retear.Results: Tear-size area was the most accurate predictor of retear (area under the curve [AUC] = 0.77; 95% confidence interval [CI] = 0.72 to 0.81), followed by 6-week passive external rotation (AUC = 0.67; 95% CI = 0.63 to 0.72), 6-week passive forward flexion (AUC = 0.67; 95% CI = 0.62 to 0.72), age (AUC = 0.65; 95% CI = 0.60 to 0.70), tear type (partial-thickness versus fullthickness) (AUC = 0.65; 95% CI = 0.61 to 0.69), and hospital type (public versus private) (AUC = 0.43; 95% CI = 0.37 to 0.49). Patients with smaller tears, reduced 6-week passive external rotation, reduced 6-week passive forward flexion, younger age, partial-thickness tears, and operations performed in a private day surgery or hospital setting were more likely to have an intact rotator cuff repair at 6 months. The AUC of this curve was 0.84 (95% CI = 0.80 to 0.87), which indicates that this combination of factors can accurately predict 84% of retears. Reduced range of motion at 6 weeks was associated with improved repair integrity for patients with tears of >1 to 6 cm 2 ; however, this effect was less pronounced in tears of £1 cm 2 or >6 cm 2 .Conclusions: Early postoperative stiffness following arthroscopic single-row, inverted-mattress rotator cuff repair at 6 weeks was associated with an intact repair at 6 months. The protective effects of postoperative stiffness and tear size were additive. The chance of retear in patients with a tear of £1 cm 2 and external rotation of £27°at 6 weeks was 1%, while those with tears of >6 cm 2 and external rotation of >27°had a 40% chance.Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. R etear remains the most common complication of a rotator cuff repair 1 . Previous studies have identified several factors as independent predictors of retear, specifically, larger tear size, patient age, less surgeon experience, public hospital type, and full-thickness tears [2][3][4][5][6][7] .A reduction in shoulder range of motion following surgery, particularly at 6 weeks, is the second-most-common complication of rotator cuff repair surgery 8 and coincides with increasing pain, which is often interpreted by patients as a failure of the repair 9 . Some surgeons recommend secondary capsular release surgery and/or manipulation under...

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 84%

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confidence: 99%

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Tear Size and Stiffness Are Important Predictors of Retear

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“… 42 In a follow-up study with an even larger patient cohort (n = 1962), this same research team determined that patient age, tear size, hospital type (private vs. public), and case number (ie, surgeon experience) were the only significant predictors of repair integrity. 15 Taken together, these comprehensive studies suggest that patient age and tear size may be the most reliable presurgical predictors of postsurgical repair integrity.…”

Section: Discussionmentioning

confidence: 90%

Presurgical tear characteristics and estimated shear modulus as predictors of repair integrity and shoulder function one year after rotator cuff repair

Ruder¹,

Lawrence²,

Soliman³

et al. 2022

JSES International

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Background Rotator cuff repair provides pain relief for many patients; however, retears are relatively common and affect approximately 20%-70% of patients after repair. Although magnetic resonance imaging (MRI) offers the ability to assess tissue characteristics such as tear size, retraction, and fatty infiltration, it provides little insight into the quality of the musculotendinous tissues the surgeon will encounter during surgery. However, shear wave elastography (SWE) could provide an indirect assessment of quality (ie, stiffness) by measuring the speed of shear waves propagating through tissue. The objective of this study was to determine the extent to which estimated shear modulus predicts repair integrity and functional outcomes 1 year after rotator cuff repair. Methods Thirty-three individuals scheduled to undergo arthroscopic rotator cuff repair were enrolled in this study. Before surgery, shear modulus of the supraspinatus tendon and muscle was estimated using ultrasound SWE. MRIs were obtained before and 1 year after surgery to assess tear characteristics and repair integrity, respectively. Shoulder strength, range of motion, and patient-reported pain and function were assessed before and after surgery. Functional outcomes were compared between groups and across time using a two-factor mixed model analysis of variance. Stepwise regression with model comparison was used to investigate the extent to which MRI and shear modulus predicted repair integrity and function at 1 year after surgery. Results At 1 year after surgery, 56.5% of patients had an intact repair. No significant differences were found in any demographic variable, presurgical tear characteristic, or shear modulus between patients with an intact repair and those with a recurrent tear. Compared with presurgical measures, patients in both groups demonstrated significant improvements at 1 year after surgery in pain ( P < .01), self-reported function ( P < .01), range of motion ( P < .01), and shoulder strength ( P < .01). In addition, neither presurgical MRI variables ( P > .16) nor shear modulus ( P > .52) was significantly different between groups at 1 year after surgery. Finally, presurgical shear modulus generally did not improve the prediction of functional outcomes above and beyond that provided by MRI variables alone ( P > .22). Conclusion Although SWE remains a promising modality for many clinical applications, this study found that SWE-estimated shear modulus did not predict repair integrity or functional outcomes at 1 year after surgery, nor did it add to the prediction of outcomes above and beyond that provided by traditional presurgical MRI measures of tear characteristics. Therefore, it appears that further research is needed to fully understan...

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“…Unsuccessful surgery leads to ongoing physical limitations, depression, anxiety and loss of independence that many perceive to have the same subjective psychological impact as other persistent medical conditions such as heart failure ( Martinez-Calderon et al , 2018 ). With an aging population and an odds ratio increase of 2.69 of a RC tear for every decade of life (p = 0.005) ( Duong et al , 2020 ) combined with the associated disability, establishing treatments that align with patients goals is of high priority for researchers, clinicians, health economists and society.…”

Section: Introductionmentioning

confidence: 99%

Large to massive rotator cuff tendon tears: a protocol for a systematic review investigating the effectiveness of exercise therapy on pain, disability and quality of life

et al. 2021

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Background: Rotator cuff tendon tears are inextricably linked with the natural process of aging often resulting in severe disability, poor quality of life and an added burden to the health care system. The occurrence of rotator cuff tendon tears increases exponentially with every decade of life to approximately 60% in individuals over 80 years of age. Exercise is a commonly prescribed intervention although research on its efficacy is in its infancy and often conflicting. The purpose of this systematic review is to investigate the effectiveness of exercise interventions for people diagnosed with large to massive rotator cuff tendon tears. Methods: This systematic review will adhere to the PRISMA reporting guidelines. A comprehensive search of five databases will be conducted. Randomised clinical trials (RCT) or quasi-randomised control trials will be included if they evaluate exercise as the core intervention or as part of the intervention in the management of large to massive rotator cuff tears. To quantify response to treatment we will compare changes in pain, disability and quality of life (QoL). The Consensus on Exercise Reporting Template (CERT) will be used to characterise the different types of exercise intervention. The Cochrane Risk of Bias Tool will be used to assess study quality. A narrative synthesis with meta-analysis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Discussion: This review will synthesise the totality of GRADE A and B evidence on the effectiveness of exercise for large to massive rotator cuff tendon tears. It will provide clinically important information and guidance for immediate implementation by clinicians, health policymakers and may be used to guide future research. PROSPERO registration: 244502 (24/03/2021)

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Anteroposterior tear size, age, hospital, and case number are important predictors of repair integrity: an analysis of 1962 consecutive arthroscopic single-row rotator cuff repairs

Cited by 25 publications

References 32 publications

Tear Size and Stiffness Are Important Predictors of Retear

Tear Size and Stiffness Are Important Predictors of Retear

Presurgical tear characteristics and estimated shear modulus as predictors of repair integrity and shoulder function one year after rotator cuff repair

Large to massive rotator cuff tendon tears: a protocol for a systematic review investigating the effectiveness of exercise therapy on pain, disability and quality of life

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