Arthroscopic repair of large to massive rotator cuff tears in patients younger than 60 years

Park, In; Choi, Youn-Ho; Kim, Yang-Soo

doi:10.1016/j.jos.2019.02.016

Cited by 11 publications

(8 citation statements)

References 26 publications

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“…Several studies evaluating the relationship between various patient-related factors and retear have emphasized the influence of structural factors, such as tear size and tendon quality, on repaired tendon integrity. 17,20,21,24,32 Unlike previous studies, our study found that a 10-year ASCVD risk score was the independent predictor of retear. Of the factors included in ASCVD risk calculation, age, diabetes, hyperlipidemia, and smoking overlapped with factors related to retear reported in previous studies.…”

Section: Discussioncontrasting

confidence: 99%

“…26 The incidence of rotator cuff repairs also has increased in older patients because of increased life expectancy and high functional demands. 24,32 Therefore, the intersection of arthroscopic rotator cuff repair and hyperlipidemia is increasing over time. A number of experimental studies have suggested that hyperlipidemia and statin use were associated with tendon healing because elevated serum lipid levels impair tendon-to-bone healing.…”

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confidence: 99%

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Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair

Lee¹,

Lee

Shin

2023

Am J Sports Med

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Background: There is no practical consensus on managing cholesterol in patients with rotator cuff repair despite hyperlipidemia and statin therapy being well-known factors in rotator cuff healing. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score is a commonly used guideline to determine statin administration for hyperlipidemia. Purpose: To identify the relationship between retear and preoperative factors, including 10-year ASCVD risk score and statin administration status, and to compare clinical outcomes and retear rates between patients who are taking and not taking statins. Study Design: Case-control study; Level of evidence, 3. Methods: This study enrolled 182 patients with a symptomatic full-thickness rotator cuff tear who underwent arthroscopic repair. Serum lipid profile, 10-year ASCVD risk score, statin eligibility, and statin administration status were assessed. Patients were categorized into 2 groups based on magnetic resonance imaging to evaluate cuff integrity at postoperative 6 months: a healed group and a retear group. Radiographic and intraoperative factors related to retear were analyzed. Multiple regression analysis was performed to evaluate factors related to rotator cuff retear. For the subgroup analysis, patients eligible for statin therapy were divided into 2 subgroups according to administration status. Results: There were 149 (81.9%) patients in the healed group and 33 (18.1%) in the retear group. In the multiple regression analysis, missed statin therapy, 10-year ASCVD risk score, and fatty infiltration of the infraspinatus muscle were the independent factors related to retear. The cutoff value for 10-year ASCVD risk score was 11.85%, with a sensitivity of 0.75 and a specificity of 0.62. In the subgroup analysis of 104 patients eligible for statin therapy, 66 (63.5%; group 1) received statin therapy and 38 (36.5%; group 2) missed it. Group 2 showed a significantly higher retear rate than group 1 (36.8% vs 13.6%; P = .006). Conclusion: Missed statin therapy, 10-year ASCVD risk score, and fatty infiltration of the infraspinatus were the independent factors associated with rotator cuff retear. Patients who missed statin therapy showed a higher retear rate than patients receiving statin therapy. Optimal statin therapy for patients who undergo arthroscopic rotator cuff repair might improve repair integrity.

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Section: Discussioncontrasting

confidence: 99%

mentioning

confidence: 99%

Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair

Lee¹,

Lee

Shin

2023

Am J Sports Med

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“…The current study found no association of age and clinical outcomes after MRCT repair, calling into question the clinical significance of reduced healing potential in elderly patients. This is in line with a study by Park et al 26 comparing the results of mostly double-row MRCT repairs in patients over and under 60 years old, matched according to tear size. No significant differences were found in postoperative clinical scores between the groups.…”

Section: Discussionsupporting

confidence: 92%

“…The authors speculated that the higher pain scores in the older cohort were because of a higher retear rate (33.3% vs 13.5%; P = .08) and more advanced fatty degeneration in the older group. 26 The present study did not include patients with Goutallier grade 4 fatty degeneration, which may explain the discrepancy in results.…”

Section: Discussionmentioning

confidence: 84%

Minimum 5-Year Clinical Outcomes of Arthroscopically Repaired Massive Rotator Cuff Tears: Effect of Age on Clinical Outcomes

Hazra

Hanson

et al. 2023

Am J Sports Med

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Background: Massive rotator cuff tears (MRCTs) can be challenging to treat, and the efficacy of repair of MRCTs in older patients has been debated. Purpose: To report minimum 5-year outcomes after primary arthroscopic rotator cuff repair of MRCT and determine whether age affects outcomes. Study Design: Case series; Level of evidence 4. Methods: The study included consecutive patients with MRCTs who were treated with arthroscopic rotator cuff repair by a single surgeon between February 2006 and October 2016. MRCTs were defined as ≥2 affected tendons with tendon retraction to the glenoid rim and/or a minimum exposed greater tuberosity of ≥67. Patient-reported outcome (PRO) data collected preoperatively and at a minimum of 5 years included the American Shoulder and Elbow Surgeons (ASES) score; Single Assessment Numeric Evaluation (SANE) score; the shortened version of the Disabilities of the Arm, Shoulder and Hand score (QuickDASH); the 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS); and patient satisfaction. Surgical failure was defined as subsequent revision rotator cuff surgery or conversion to reverse total shoulder arthroplasty. Regression analysis was performed to determine whether age had an effect on clinical outcomes. Results: A total of 53 shoulders in 51 patients (mean age, 59.7 years; range, 39.6-73.8 years; 34 male, 19 female) met inclusion criteria with a mean follow-up of 8.1 years (range, 5.0-12.1 years). Three shoulders (5.7%) failed at 2.4, 6.0, and 7.1 years. Minimum 5-year follow-up was obtained in 45 of the remaining 50 shoulders (90%). Mean PROs improved as follows: ASES from 58.8 to 96.9 ( P < .001), SANE from 60.5 to 88.5 ( P < .001), QuickDASH from 34.2 to 6.8 ( P < .001), and SF-12 PCS from 41.1 to 52.2 ( P < .001). Patient satisfaction was a median of 10 (on a scale of 1-10). Age was not associated with any PRO measures postoperatively ( P > .05). Conclusion: This study demonstrated significantly improved clinical scores, decreased pain, and increased return to activity for patients with MRCT at midterm follow-up (mean, 8.1 years; range, 5.0-12.1 years). In this patient cohort, no association was found between age and clinical outcomes.

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“…[10][11][12] However, the optimal management of LMRCTs remains controversial. [13][14][15][16] Anterior Posterior a b Flow diagram of the patient enrolment and data analysis procedure. BSCR, biceps superior capsular reconstruction; FTRCT, full-thickness rotator cuff tear; RC, rotator cuff; SCR, superior capsular reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic biceps augmentation does not improve clinical outcomes during incomplete repair of large to massive rotator cuff tears

Park

Kim

et al. 2022

The Bone & Joint Journal

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Aims This study compared patients who underwent arthroscopic repair of large to massive rotator cuff tears (LMRCTs) with isolated incomplete repair of the tear and patients with incomplete repair with biceps tendon augmentation. We aimed to evaluate the additional benefit on clinical outcomes and the capacity to lower the re-tear rate. Methods We retrospectively reviewed 1,115 patients who underwent arthroscopic rotator cuff repair for full-thickness tears between October 2011 and May 2019. From this series, we identified 77 patients (28 male, 49 female) with a mean age of 64.1 years (50 to 80). Patients were classified into groups A (n = 47 incomplete) and B (n = 30 with biceps augmentation) according to the nature of their reconstruction. Clinical scores were checked preoperatively and at six months, one year, and two years postoperatively. In preoperative MRI, we measured the tear size, the degree of fatty infiltration, and muscle volume ratio of the supraspinatus. In postoperative MRI, the integrity of the repaired rotator cuff tendon was assessed using the Sugaya classification. Tendon thickness at the footprint was evaluated on T2-weighted oblique coronal view. Results There were no significant differences in the initial preoperative demographic characteristics. In both groups, there were significant improvements in postoperative clinical scores (p < 0.001). However, most clinical outcomes, including range of motion measurements (forward elevation, external rotation, internal rotation, and abduction), showed no differences between the pre- and postoperative values. Comparing the postoperative outcomes of both groups, no further improvement from biceps augmentation was found. Group B, although not reaching statistical significance, had more re-tears than group A (30% vs 15%; p = 0.117). Conclusion In LMRCTs, biceps augmentation provided no significant improvement of an incomplete repair. Therefore, biceps augmentation is not recommended in the treatment of LMRCTs. Cite this article: Bone Joint J 2022;104-B(11):1234–1241.

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Arthroscopic repair of large to massive rotator cuff tears in patients younger than 60 years

Cited by 11 publications

References 26 publications

Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair

Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair

Minimum 5-Year Clinical Outcomes of Arthroscopically Repaired Massive Rotator Cuff Tears: Effect of Age on Clinical Outcomes

Arthroscopic biceps augmentation does not improve clinical outcomes during incomplete repair of large to massive rotator cuff tears

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