Combination of risk factors affecting retear after arthroscopic rotator cuff repair: a decision tree analysis

Abstract

Background: Several risk factors for postoperative retear after arthroscopic rotator cuff repair (ARCR) have been cited in a large number of reports; various combinations of these seem to be present in the clinical setting. Purpose: Using a combination model for decision tree analysis, we aimed to investigate the combination of risk factors that affect postoperative retear the most. Methods: A total of 286 patients who underwent magnetic resonance (MR) imaging at 6 months after surgery were included in this study. Based on the structural integrity of the MR images taken 6 months after surgery, the patients were divided into a healed group (intact tendon, 254 patients) and a retear group (ruptured tendon, 32 patients). Using univariate and decision tree analyses, we selected a combination of 11 risk factors that drastically affected postoperative retear. Results: The mean age was 64.9 AE 7.1 years, and the mean symptom duration was 9.7 AE 11.6 months. The tear was small/medium in 177 patients and large/massive in 109 patients. The technique for surgical repair was single row in 42 patients, double row in 60 patients, and suture bridging in 216 patients. On univariate analysis, both groups had significant differences in the anteroposterior (AP) tear size (P < .0001), mediolateral tear size (P < .0001), hyperlipidemia (P ¼ .0178), global fatty degeneration index (P < .0001), supraspinatus fatty degeneration stage (P < .0001), and critical shoulder angle (CSA) (P ¼ .0015). All of these 5 risk factors, except for mediolateral tear size, were selected as candidates for the decision tree analysis. Eight combination patterns were determined to have prediction probabilities that ranged from 4.3% to 86.1%. In particular, the combination of an AP tear size of !40 mm, hyperlipidemia, and a CSA of !37 affected retear after ARCR the most.The study was approved by the Health Sciences Institutional Review Board of Fukuoka Shion Hospital (approval no. 7).

Dyslipidemia is associated with risk for rotator cuff repair failure: a systematic review and meta-analysis

“…Circulation-derived lipid deposits in tendon extracellular matrix have been widely observed in nonfamilial hypercholesterolemia patients. The present research suggests that these deposits cause oxidative damage, persistent inflammatory cytokine production, obstructed tissue vascularity, 8 Retrospective cohort III ++++ + Satisfactory Cancienne et al, 2017 11 Retrospective cohort III ++++ + +++ Excellent Garcia et al, 2017 23 Retrospective cohort III ++++ ++ Good Harada et al, 2021 25 Retrospective cohort III ++++ +++ Good Kim et al, 2017 31 Retrospective cohort III ++++ ++ ++ Excellent Zheng et al, 2020 61 Retrospective cohort III ++++ ++ Good Jeong et al, 2018 30 Caseecontrol III ++++ + + Good Lee et al, 2020 38 Caseecontrol III +++ + ++ Good O'Donnell et al, 2020 46 Case series IV ++++ + +++ Excellent Park et al, 2020 49 Case series IV ++++ ++ ++ Excellent and reduced cholesterol efflux and matrix turnover by macrophages and tenocytes. 2,5,11,55 In a recent study by Li et al, 39 high cholesterol inhibited gene expression in tendon-derived stem cells, a newly identified resident cell population theorized to be responsible for tendon maintenance and repair.…”

“…Meta-analysis was performed with results from 7 studies 4,23,25,30,31,46,49 reporting retear among DLD patients; Cancienne et al 11 were excluded because of patient overlap with O'Donnell et al 46 In total, 42,402 subjects were included, 52.8% of which had DLD. Patient age ranged from 45.3 to 84 years, with 54.0% males.…”

Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review

“…Meta-analysis showed that rotator cuff retear was more likely with increasing body mass index (BMI) (WMD 0.52, 95% CI 0.23, 0.82; P < .001). A total of 7 studies 10,26,35,36,40,44,46,53 reported the impact of diabetes on rotator cuff healing. Meta-analysis showed that diabetes was a risk factor for retear after ARCR (OR 1.42, 95% CI 1.02, 1.97; P ¼ .04).…”

Re-tears after rotator cuff repair: Current concepts review

“…13,23,31,32 Predictive algorithms have been developed based on these risk factors and are based on anteroposterior tear size and age being more heavily weighted in providing a percentage risk of re-tear. 18,25 A summary of risk factors and their relative effects on re-tear rates are summarised in Table 1.…”