Factors associated with the development of re-tear following arthroscopic rotator cuff repair: A retrospective comparative study

Abstract

Objective: The aim of this study was to analyze the risk factors for the development of re-tear following Arthroscopic Rotator Cuff Repair (aRCR). Methods: This retrospective clinical study included 196 consecutive aRCRs with a minimum 3-year follow-up. Pre- and postoperative clinical and functional outcomes were measured using the Visual Analog Scale (VAS), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the University of California at Los Angeles Shoulder Rating Scale (UCLA), the Constant-Murley Score (CMS), and the Douleur Neuropathique (DN4) questzionnaire. The Goutallier staging of fatty infiltration, Occupational Ratio (OR), the Acromiohumeral Interval (AHI), Acromioclavicular Joint (ACJ) arthritis, acromion type, Critical Shoulder Angle (CSA), and tangent sign (tan- sign) were evaluated as radiological parameters. Different subgroup parameters were evaluated after dividing the patients into re-tear (-) and re-tear (+) groups, according to clinical and radiological outcomes as well as patient and intraoperative characteristics. Results: The mean follow-up period was 72.0 ± 15.8 months. The mean age at the time of surgery was 58.4 ± 8.9 years. A significant improvement was found in clinical and functional scores in the re-tear (-) group (P < 0.001 for all). However, the retear (+) group had poorer outcome scores than the re-tear (-) group. Twenty patients (10.2%) had re-tear at the last follow-up. There was a significant difference between groups regarding pre-and postoperative clinical scores, with worse scores in the retear (+) group (P < 0.001 for all). Also, pre-and postoperative pseudoparalysis (P = 0.001 for both), acromioclavicular joint arthritis (ACJ) (P = 0.001), intraoperative rotator cuff wear (P = 0.007) or stiffness (P = 0.025), a longer time period between symptom onset and surgery (P = 0.031), larger tear size (P = 0.010), preoperative shoulder stiffness (P = 0.001), higher duration of postoperative analgesia use (P < 0.001), higher degrees of preoperative Occupational Ratio (OR) (P < 0.001), and higher degrees of fatty degeneration (P < 0.001) were found to be associated with re- tear development. Conclusion: Surgeons should consider the preoperative degree of fatty degeneration, clinical and functional scores, presence of ACJ arthritis, intraoperative tendon quality, tear size and chronicity as well as postoperative prolong analgesic requirement, and development of pseudoparalysis as factors regarding re-tear development risk following aRCR.