Preoperative tendon retraction, not smoking, is a risk factor for failure with continuity after rotator cuff repair

Abstract

Background: Smoking is a poor prognostic factor for healing after rotator cuff repair and is associated with inferior results. We hypothesized that smokers would have higher recurrent tear rates and more postoperative myotendinous junction (MTJ) retraction in healed repairs than nonsmokers three months postoperatively. Methods: Rotator cuff repairs (RCRs) were retrospectively reviewed over a 2-year period. Patients underwent magnetic resonance imaging (MRI) within 6 months prior to surgery and again at 3 months postoperatively. Seventy-nine patients were included and stratified by smokers versus nonsmokers. Baseline patient demographics, tear characteristics, and surgical factors were collected. Preoperative and postoperative MRIs were assessed to quantify the MTJ position and to establish the recurrent tear rate. Results: For the total cohort (nonsmokers, n ¼ 56; smokers, n ¼ 23), significant differences in age, race, and traumatic onset of injury existed between groups. There were no significant differences in recurrent tear between smokers (26%) and nonsmokers (27%), but nonsmokers were more satisfied. For patients with healed RCRs (nonsmokers, n ¼ 41; smokers, n ¼ 17), there were significant differences in race. On univariate analysis, nonsmokers had a significantly more lateral MTJ postoperatively (P ¼ 0.05). On multivariable regression analysis, medialized postoperative MTJ position in healed cuffs was driven only by greater preoperative rotator cuff retraction preoperatively. There were no significant differences in MTJ position based on smoking status for patients with healed RCRs. Conclusion: Smoking does not appear to be an independent risk factor for postoperative MTJ retraction in healed RCRs, also known as failure in continuity. Preoperative tear size and retraction play the biggest roles in predicting postoperative MTJ position, regardless of smoking status. There are no significant differences in patient-reported outcomes for patients with healed RCRs, but nonsmokers had more satisfaction following RCR in the total cohort.

Editorial Commentary: Long Head Biceps Tendon Can Be Used Like a Split Skin Graft: Mesh It and Augment Rotator Cuff Repairs

“…6 Preoperative tear size and retraction are the main reported risk factors for poorer clinical outcomes and retear rates. 7 Not surprisingly, shoulder surgeons have explored whether augmentation of cuff repair would not only result in better cuff integrity but also reduce retear rates. 5,[8][9][10] An earlier study by Barber et al has been promising reporting intact repairs in 85% compared with 40% in nonaugmented repairs at a mean follow-up of two years.…”

Editorial Commentary: Monitoring Tendon and Muscle Recovery After Rotator Cuff Repair Using Diagnostic Ultrasound Demonstrates that Early Repair is Beneficial for Many Patients With Reparable Tears

“…Previous study has demonstrated that retracted tears are a risk factor for retears with continuity. 36 The myotendinous junction retracts in these retears with continuity, which would obviously influence pennation angle and cross-sectional area measures.…”