Increasing age and tear size reduce rotator cuff repair healing rate at 1 year

Abstract

Background and purpose — There is a need to understand the reasons why a high proportion of rotator cuff repairs fail to heal. Using data from a large randomized clinical trial, we evaluated age and tear size as risk factors for failure of rotator cuff repair.Patients and methods — Between 2007 and 2014, 65 surgeons from 47 hospitals in the National Health Service (NHS) recruited 447 patients with atraumatic rotator cuff tendon tears to the United Kingdom Rotator Cuff Trial (UKUFF) and 256 underwent rotator cuff repair. Cuff integrity was assessed by imaging in 217 patients, at 12 months post-operation. Logistic regression analysis was used to determine the influence of age and intra-operative tear size on healing. Hand dominance, sex, and previous steroid injections were controlled for.Results — The overall healing rate was 122/217 (56%) at 12 months. Healing rate decreased with increasing tear size (small tears 66%, medium tears 68%, large tears 47%, and massive tears 27% healed). The mean age of patients with a healed repair was 61 years compared with 64 years for those with a non-healed repair. Mean age increased with larger tear sizes (small tears 59 years, medium tears 62 years, large tears 64 years, and massive tears 66 years). Increasing age was an independent factor that negatively influenced healing, even after controlling for tear size. Only massive tears were an independent predictor of non-healing, after controlling for age.Interpretation — Although increasing age and larger tear size are both risks for failure of rotator cuff repair healing, age is the dominant risk factor.

Effectiveness of Dextrose Prolotherapy for Rotator Cuff Tendinopathy: A Systematic Review

“…Rotator cuff tendinopathy is one of the most common musculoskeletal conditions and the most common shoulder pathology, affecting 15% to 50% of the population and increasing in prevalence with age . It is a unique challenge for physicians as it presents with a wide range of pathologies, which only loosely correlate to symptoms.…”

“…Rotator cuff tendinopathy pathology can range from tendinosis, calcific tendinitis, partial‐ and full‐thickness tears, to large and massive irreparable rotator cuff tears affecting any combination of the four rotator cuff tendons. Patients with milder disease including tendinosis, calcific tendinitis, and partial‐thickness tears typically report a predominance of pain with some degree of weakness and/or loss of range of motion with associated functional limitations . The optimal treatment for rotator cuff tendinopathy remains unknown.…”

Cellular Plasticity in Musculoskeletal Development, Regeneration, and Disease

“…During reprogramming, promoters of pluripotent genes are demethylated and reprogrammed cells re‐establish the bivalent chromatin domains which poise them to rapidly activate new genetic programs . Complete reprogramming, therefore, requires large‐scale chromatin remodeling . In fact, iPSC reprogramming efficiency can be improved by using epigenetic chromatin modulators such as histone deacetylase and methyltransferase inhibitors .…”

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Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

“…These procedures usually result in the formation of inferior scar tissue which is more prone to re‐rupture. For instance, 63% of large and 73% of massive rotator cuff tears fail to heal following surgical repair . Despite the impact of these injuries, there is limited research on the fundamental biology that governs tendon and ligament development and healing.…”