Clinical effect of modified anterolateral acromioarthroplasty during arthroscopic rotator cuff repair.

BACKGROUND: This study aimed to compare the clinical effect of modified anterolateral and traditional acromioplasty in arthroscopic rotator cuff repair. METHODS: The clinical data of 92 patients with total rotator cuff tears admitted to the Department of Joint Surgery of Jinhua Central Hospital from January 2016 to December 2019 were retrospectively analyzed. Among them, 42 patients underwent traditional acromioplasty during arthroscopic rotator cuff repair, and 50 underwent modified anterolateral acromioplasty. Patients were evaluated for preoperative and postoperative shoulder function, pain and critical shoulder angle, and incidence of rotator cuff re-tear at 12 months postoperatively. RESULTS: The preoperative general data of patients in the classic and modified anterolateral acromioplasty groups did not differ significantly (P > 0.05) and were comparable. The UCLA, ASES, and Constant shoulder joint scores were significantly improved in both groups. The VAS score was significantly decreased at 12 months postoperative than preoperative, with a statistically significant difference (P ≤ 0.05). Shoulder function and pain scores did not differ significantly between the two groups at 12 months postoperatively (P > 0.05). The CSA did not differ significantly between preoperative and postoperative 12 months in the traditional acromioplasty group (P > 0.05). However, 12 months postoperative CSA in the modified anterolateral acromioplasty group was significantly smaller than the preoperative CSA, with a statistically significant difference (P ≤ 0.05). The rates of rotator cuff re-tears were 16.67% (7/42) and 4% (2/50) in the two groups at 12 months postoperatively, respectively, with statistically significant differences (P ≤ 0.05). CONCLUSIONS: Traditional and modified anterolateral acromioplasty while treating total rotator cuff tears using arthroscopic rotator cuff repair significantly improves shoulder joint function. However, modified anterolateral acromioplasty significantly reduced the CSA value and decreased the incidence of rotator cuff re-tears.

Which is better? Early versus delayed rehabilitation after arthroscopic rotator cuff repair.

PURPOSE: This study aimed to compare the 5-year clinical and functional outcomes, including repaired tendon healing status, between early and delayed rehabilitation after arthroscopic rotator cuff repair METHODS: A total of 75 patients with rotator cuff tears (less than 5 cm) underwent arthroscopic repairs over a 60-month period. Participants were randomly assigned to early and delayed postoperative rehabilitation groups with distinct protocols. Clinical and functional outcome measures included Constant score, University of California at Los Angeles (UCLA) score, visual analogue scale for pain and isokinetic dynamometer test for muscle strength recovery. Clinical and functional scores were compared between baseline and 5 years postoperatively. Radiologic assessment via magnetic resonance imaging was performed at a minimum of 12 months postoperatively for evaluations of tendon integrity and recurrent tears. RESULTS: Baseline characteristics showed no statistically significant differences between groups. Both groups demonstrated equivalent improvement in range of motion and pain scores with no statistical differences. Clinical scores improved significantly in both groups by postoperative 12 months and plateaued. At the postoperative 5-year mark, the early group showed better improvement in the visual analogue scale and UCLA score, while the delayed group had superior Constant scores. Postoperative magnetic resonance imaging revealed six recurrent tears, two in the early group and four in the delayed group, with no statistical differences. Muscle strength recovery showed no differences between the two groups. CONCLUSION: Both the early and the delayed rehabilitation groups showed similar outcomes in postoperative range of motion, functional scores, muscle strength recovery and tendon healing in the short- and mid-term follow-ups. LEVEL OF EVIDENCE: Level III.

Outcomes of arthroscopic single-row repair alone vs. repair with human dermal allograft patch augmentation in patients with large to massive, posterosuperior rotator cuff tears: a retrospective comparative study.

BACKGROUND: Large to massive rotator cuff tears (RCTs) affect shoulder functions profoundly with unmanageable disability without intervention. The retear rates with arthroscopic rotator cuff repair (ARCR) in these patients are abysmal. Patch augmentation has been credited for preventing retears, improving functions by increasing the strength, and acting as a bioconductive scaffold. This study aimed to assess the retear rates and compare the clinical and radiological outcomes between the ARCR with and without acellular human dermal allograft (HDA) augmentation. METHODS: This is a retrospective comparative study among patients diagnosed with large to massive, posterosuperior RCTs, operated between January 2020 and December 2021, including 36 patients (group I) with and 131 patients (group II) without HDA augmentation, with a mean follow-up of 20 (range, 12-35) months. The average age was 64 (range, 49-80) and 66 (range, 41-81) years in groups I and II, respectively. In group I, there were 16 male and 20 female patients, whereas in group II, there were 58 male and 73 female patients. RESULTS: The visual analog scale score improved to 1.1 ± 1.7 in group I and 2.1 ± 1.7 in group II (P = .005). There was a greater improvement in the University of California, Los Angeles shoulder score to 30.1 ± 4.2 in group I compared with 23.2 ± 3.9 in group II (P = .046). Forward flexion (degrees) improved from a mean of 103.2 ± 18.6 to 138.9 ± 23.5 in group I and from 106.4 ± 21.3 to 127.0 ± 19.5 in group II (P = .004). The acromiohumeral interval (mm) measured in anteroposterior radiographs increased to 8.4 ± 1.8 in group I and 8.2 ± 2.0 in group II (P = .006). The satisfaction after the procedure was 4.4 ± 0.6 in group I and 3.1 ± 1.1 in group II (P = .044). The retear rate in the HDA-augmented group was 5.6% as compared with 29.1% in the nonaugmented group, which was statistically significant (P = .007). There were no complications or adverse tissue reactions against HDA seen in any patients. CONCLUSION: In patients with large to massive, posterosuperior RCTs, patch augmentation with acellular HDA significantly averted the retears after ARCR without any graft-related complications. The augmentation also resulted in improved shoulder function and greater range of motion compared with the nonaugmented group.

Revision rotator cuff repair: can a Sugaya III tendon considered to be healed or not.

BACKGROUND: Sugaya et al described a classification system to assess postoperative rotator cuff tendon healing. Although Sugaya I and II tendons can be considered as healed and Sugaya type IV and V can be considered as retorn, the exact status of Sugaya III tendons remains unclear. The objective of this study was to evaluate the impact of Sugaya III tendons on postoperative functional scores in a population of patients undergoing revision rotator cuff repair. METHODS: We retrospectively studied the records of all patients who underwent revision rotator cuff repair in one of 12 different institutions between July 2001 and December 2020. A total of 203 shoulders were included (59% males, mean age: 51 ± 8 years old, mean follow-up 11.5 years [range: 2-28.8 yr]). Fifty-four patients (61% males, mean age 52 ± 6 years old, mean follow-up 14.1 years [range: 10.4-28.8 yr]) had a follow-up ≥10 years (mean 14.1 years [range: 10.4-28.8 yr]) and were included in a long-term follow-up subgroup analysis. Structural integrity of the repaired tendon was evaluated on magnetic resonance imaging at last follow-up. Functional scores, acromiohumeral index (AHI), and progression of fatty infiltration and of osteoarthritis were compared according to Sugaya type. RESULTS: Mean Constant score and mean strength were significantly higher in Sugaya I and II tendons than in Sugaya III (P = .021 and .003) and Sugaya IV and V tendons (P = .07 and .038), but did not differ between Sugaya III and Sugaya IV and V tendons. Mean Subjective Shoulder Value, pain, AHI were significantly higher and fatty infiltration and progression in the Hamada classification were significantly lower in Sugaya I and II tendons and in Sugaya III than in Sugaya IV and V tendons (P < .05), but did not differ between Sugaya I and II and Sugaya III tendons. Similar characteristics could also be observed in the long-term follow-up subgroup. CONCLUSION: Sugaya III tendons after revision rotator cuff repair do not allow restoration of strength thereby impacting the Constant score. However, there seems to be a protective effect of Sugaya III tendons with regard to pain, progression of proximal migration of the humeral head, osteoarthritis, and fatty infiltration, which seems to last at long-term follow-up.

Long-term results of revision rotator cuff repair for failed cuff repair: a minimum 10-year follow-up study.

HYPOTHESIS: Rotator cuff repair remains associated with high retear rates, which range from 13% to 79%. The objective of this study was to evaluate the long-term clinical and structural results after revision rotator cuff repair at a minimum 10-year follow-up. METHODS: We retrospectively studied the records of all patients who underwent revision rotator cuff repair in 3 different institutions between July 2001 and December 2007 with a minimum 10-year follow-up. A total of 54 patients (61% males, mean age 52 ± 6 years old) met the inclusion criteria. Outcome measures included pain (visual analog scale [VAS]), range of motion (ROM), Subjective Shoulder Value (SSV), and the Constant score. Superior migration, osteoarthritis, and acromiohumeral interval (AHI) were assessed on standard radiographs. Fatty infiltration and structural integrity of the repaired tendon were evaluated on magnetic resonance imaging or computed tomographic arthrogram. RESULTS: At a mean 14.1 years (10.4-20.5), range of motion did not progress significantly in elevation and internal rotation between pre- and postoperation (158° [range, 100°-180°] to 164° [range, 60°-180°], P = .33, and L3 [range, sacrum-T12] to T12 [range, buttocks-T7], P = .34, respectively) and decreased in active external rotation from 45° (range, 10°-80°) to 39° (range, 10°-80°) (P = .02). However, VAS, SSV, and Constant score were all significantly improved at last follow-up (P < .001). AHI decreased significantly (P = .002) from 10 mm (7-14 mm) to 8 mm (0-12 mm). Two percent of the supraspinatus/infraspinatus tendons were Sugaya 1, 24% were Sugaya 2, 35% were Sugaya 3, 12% were Sugaya 4, and 27% were Sugaya 5. Goutallier score progressed for all muscles, but this did not reach significance and mean Goutallier remained <2 for all 4 muscles at last follow-up. Hamada score progressed from 0% >grade 2 preoperatively to 6% >grade 2 at last follow-up. CONCLUSION: Revision rotator cuff repair provides significant pain relief and improvement in functional scores at long-term follow-up. The mild progression of fatty infiltration, AHI, and Hamada score suggests that despite high retear rates (39% of stage 4 and 5 in the Sugaya classification), revision repair could possibly have a protective role on the evolution toward cuff tear arthropathy.

Re-tear after arthroscopic rotator cuff tear surgery: risk analysis using machine learning.

BACKGROUND: Postoperative rotator cuff retear after arthroscopic rotator cuff repair (ARCR) is still a major problem. Various risk factors such as age, gender, and tear size have been reported. Recently, magnetic resonance imaging-based stump classification was reported as an index of rotator cuff fragility. Although stump type 3 is reported to have a high retear rate, there are few reports on the risk of postoperative retear based on this classification. Machine learning (ML), an artificial intelligence technique, allows for more flexible predictive models than conventional statistical methods and has been applied to predict clinical outcomes. In this study, we used ML to predict postoperative retear risk after ARCR. METHODS: The retrospective case-control study included 353 patients who underwent surgical treatment for complete rotator cuff tear using the suture-bridge technique. Patients who initially presented with retears and traumatic tears were excluded. In study participants, after the initial tear repair, rotator cuff retears were diagnosed by magnetic resonance imaging; Sugaya classification types IV and V were defined as re-tears. Age, gender, stump classification, tear size, Goutallier classification, presence of diabetes, and hyperlipidemia were used for ML parameters to predict the risk of retear. Using Python's Scikit-learn as an ML library, five different AI models (logistic regression, random forest, AdaBoost, CatBoost, LightGBM) were trained on the existing data, and the prediction models were applied to the test dataset. The performance of these ML models was measured by the area under the receiver operating characteristic curve. Additionally, key features affecting retear were evaluated. RESULTS: The area under the receiver operating characteristic curve for logistic regression was 0.78, random forest 0.82, AdaBoost 0.78, CatBoost 0.83, and LightGBM 0.87, respectively for each model. LightGBM showed the highest score. The important factors for model prediction were age, stump classification, and tear size. CONCLUSIONS: The ML classifier model predicted retears after ARCR with high accuracy, and the AI model showed that the most important characteristics affecting retears were age and imaging findings, including stump classification. This model may be able to predict postoperative rotator cuff retears based on clinical features.

Clinical outcomes of medialized single-row repair with fascia lata graft augmentation for large and massive rotator cuff tears.

BACKGROUND: A high postoperative retear rate after arthroscopic rotator cuff repair (ARCR) of large and massive tears remains a problem. This study evaluated rotator cuff integrity after ARCR with fascia lata graft augmentation for large and massive rotator cuff tears and compared clinical outcomes between patients with intact repairs and retears. METHODS: Forty-five patients with rotator cuff tears who could not undergo primary repair due to tendon retraction underwent arthroscopic medialized single-row repair with fascia lata graft augmentation. The patients' minimum follow-up was 2 (2-9) years. Supraspinatus cuff integrity was evaluated postoperatively by magnetic resonance imaging. We compared the clinical outcomes of patients with intact repairs vs. retears based on the University of California-Los Angeles (UCLA), Constant, and Japanese Orthopaedic Association (JOA) scores. We also evaluated their range of motion (ROM) and muscle strength. RESULTS: Retears were observed in 11 of 45 patients. UCLA, Constant, and JOA scores significantly improved postoperatively compared to preoperatively in the intact repair (all P < .001) and retear (all P < .036) groups. The intact repair group had significantly higher Constant (75.6 [mean] ± 9.9 [SD] vs. 69.8 ± 7.9; P = .026) and JOA (94.4 ± 6.9 vs. 89.8 ± 5.9; P = .041) scores than the retear group. Forward elevation, abduction, and the strengths of abduction and external rotation significantly improved in the intact repair group (all P < .003) but not in the retear group (all P > .05). The intact repair group had significantly higher postoperative forward flexion (165° ± 15° vs. 154° ± 23°; P = .036), abduction (164° ± 17° vs. 151° ± 26°; P = .029), and abduction strength (3.5 ± 2.2 kg vs. 2.3 ± 1.2 kg; P = .017) than the retear group. In the intact repair group (n = 34), Sugaya type I:II ratio differed significantly between postoperative 3 months (2:32) and 24 months (24:10) (P < .001). Repaired tendon thickness did not decrease significantly between 3 months (7.1 mm) and 2 years (6.9 mm) (P = .543). CONCLUSIONS: ARCR with fascia lata graft augmentation of large and massive rotator cuff tears showed a 24.4% retear rate but significantly improved the clinical scores, ROMs, and muscle strength with excellent cuff integrity in the intact repair group. However, the differences in the Constant and UCLA scores between the intact repair and retear groups were under the minimal clinically important difference, and their clinical significance is uncertain. Our results confirm that ARCR with fascia lata graft augmentation improves patients' postoperative outcomes if the repair site is maintained postoperatively.

Perioperative glycemic control reduces the risk of retear in diabetic patients following arthroscopic rotator cuff repair: A meta-analysis.

BACKGROUND: Previous studies have associated diabetes with reduced shoulder motion, increased pain, and higher postoperative retear risk after arthroscopic rotator cuff repair (ARCR). However, the impact of glycemic control, measured by hemoglobin A1c (HbA1c) levels, on retear and revision rates after ARCR in diabetic patients remains unclear. METHODS: This systematic review was conducted using the PubMed, Cochrane Library, Web of Science, and Embase databases according to the preferred reporting conventions for systematic reviews and meta-analyses. Only studies that compared retears and revisions in ARCR patients with documented HbA1c levels between controlled and uncontrolled diabetes groups were included. Relevant data were extracted and analyzed using STATA software. The methodological index for nonrandomized studies was employed to assess the risk of bias in the selected studies. Additionally, heterogeneity tests and sensitivity analyses were conducted to evaluate potential heterogeneity within the samples, and publication bias was also detected. RESULTS: Six studies (4395 patients), including five retrospective cohort studies and one case‒control study, were included. Four of these studies assessed retears involving 253 patients. Lower HbA1c levels, indicating better glycemic control, were significantly associated with reduced retear rates after ARCR in diabetic patients (P = 0.000; odds ratio = 0.242, 95 % confidence interval: 0.128-0.454; I2 = 25 %). For revision evaluations, two studies, with a total of 4142 patients, found no significant difference in rates between controlled and uncontrolled diabetes groups, and no publication bias was detected. CONCLUSION: Following ARCR in diabetic patients, effective glycemic control significantly reduces retear rates without affecting revisions, and maintaining glycemic control in the postoperative period may contribute to rotator cuff healing.

A retrospective comparative study of surgical outcomes following femoral fascia patching and iliotibial ligament bony patching for primary irreparable rotator cuff tears in a geriatric population.

INTRODUCTION: We performed two surgical techniques for primary irreparable rotator cuff tears: a patch technique using the femoral fascia as a graft (F technique) and a patch technique using the bony iliotibial ligament (I technique). We then evaluated the outcomes of both surgical methods. MATERIALS AND METHODS: This study included 28 patients who were diagnosed with primary irreparable rotator cuff tears from April 2008 to April 2014. Among them, 13 underwent the F technique, whereas 15 underwent the I technique. Each clinical shoulder score was evaluated preoperatively and 2 years after surgery. The cuff integrity was evaluated via magnetic resonance imaging 2 years after surgery, with cases suffering a retear after surgery undergoing retear site examination. In group I, computed tomography (CT) was performed 3-4 months after surgery to investigate the bony part of the patch and bony fusion of the footprint. RESULTS: Both groups showed significant improvements in the pre- and postoperative mean clinical score values. Group I had significantly better postoperative scores than group F. Postoperative retear rates were 33.3% and 76.9% for groups I and F, respectively, with group I having a significantly lower retear rate (P = 0.03). All 5 retears in group I were located at the suture between the residual rotator cuff and the graft, whereas 7 of the 10 retears in group F were located at the fixation of the graft and footprint and the remaining 3 were central. CT results in group I showed that all 15 patients had bony fusion between the bony part of the patch and the footprint. CONCLUSION: The I technique was significantly superior to the F technique in terms of postoperative clinical scores and retear rates, suggesting its advantage for rotator cuff tissue reconstruction.

Socioeconomic and Other Risk Factors for Retear after Arthroscopic Surgery for Nontraumatic Rotator Cuff Tear.

Background and Objectives: Few studies have investigated the socioeconomic factors associated with retear after rotator cuff repair. This study aimed to identify the risk factors, including socioeconomic factors, for rotator cuff retear in patients who underwent arthroscopic rotator cuff repair. Materials and Methods: This retrospective study included 723 patients diagnosed with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair from March 2010 to March 2021. The outcome variable was rotator cuff retear observed on postoperative magnetic resonance imaging or ultrasonography. Sex, age, obesity, diabetes, symptom duration, and tear size were the independent variables. Socioeconomic variables included occupation, educational level, type of medical insurance, and area of residence. We compared patients with and without retear and estimated the effects of the independent factors on retear risk. Results: The mean age of the patients, symptom duration, and tear size were 62.4 ± 8.0 years, 1.8 ± 1.7 years, and 21.8 ± 12.5 mm, respectively. The age, type of medical insurance, diabetes, tear size, and symptom duration differed significantly between patients with and without retearing (p < 0.05). Age, occupation, type of medical insurance, diabetes, initial tear size, and symptom duration significantly affected the risk of retear. Patients who performed manual labor had a significantly higher retear rate (p = 0.005; OR, 1.95; 95% CI, 1.23-3.11). The highest retear risk was seen in patients with Medicaid insurance (p < 0.001; OR, 4.34; 95% CI, 2.09-9.02). Conclusions: Age, initial tear size, and symptom duration significantly affect retear risk after arthroscopic rotator cuff repair. Occupation and type of medical insurance were also risk factors for retear. Socioeconomically vulnerable patients may be at a greater risk of retear. Proactive efforts are required to expand early access to medical care.

"Functional outcomes and MRI-based tendon healing after (antero-) superior rotator cuff repair among patients under 50 years: retrospective analysis of traumatic versus non-traumatic rotator cuff tears".

BACKGROUND: Rotator cuff tears among patients under 50 years either result from an adequate trauma or are considered non-traumatic due to work-related or athletic overuse. The impact of these different mechanisms on postoperative functional outcomes and tendon healing has not yet been fully understood. Therefore, it was the purpose of this study to investigate the influence of etiology of (antero-)superior rotator cuff tears on postoperative outcomes and the healing rates after arthroscopic rotator cuff repair in a young patient population. METHODS: Patients under 50 years who underwent arthroscopic rotator cuff repair between 2006-2017 for an anterosuperior rotator cuff tear with a minimum follow up of 24 months were included in this study. Revision surgeries or reconstructive concomitant procedures other than long head of the biceps tenodesis were excluded. Patients were divided into two groups according to the etiology of their rotator cuff tear (traumatic vs. non-traumatic). Demographic and outcome scores including the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score (CS), bilateral strength measurements and postoperative tendon integrity evaluated on magnetic resonance imaging (MRI) were assessed and compared between both groups. RESULTS: The mean follow up for this study was 55.6 months (24 - 158). Twenty-one patients (50.0%) had a traumatic RCT and 21 patients (50.0%) had a non-traumatic tear. Outcome scores did not differ significantly between groups. Strength measurements of the supraspinatus revealed significantly decreased force of the affected side as opposed to the contralateral side (p = 0.001), regardless of etiology. Retear rates were similar in both groups (37.5% and 33.3%, p = n.s.). Cuff integrity at follow-up was not predictive of superior scores or strength. CONCLUSION: Surgical treatment of traumatic and non-traumatic RCT yields good clinical results in patients under the age of 50. The etiology of the rotator cuff tear did not significantly affect postoperative outcomes or healing rates. About one third of the patients suffered from a retear postoperatively, however retears were not predictive of inferior outcomes at midterm follow-up. STUDY DESIGN: Level III. TRIAL REGISTRATION: Retrospectively registered.

Factors affecting satisfaction in patients with a rotator cuff retear: CT arthrography-based study.

PURPOSE: The relationship between retear that may occur after rotator cuff repair and patient satisfaction is not well established. This study aimed to determine whether the types and size of the retear evaluated by computed tomography arthrography (CTA) influenced patient satisfaction. We also analyzed the patient factors that could affect patient satisfaction. PATIENTS AND METHODS: A total of 50 patients who were diagnosed with rotator cuff retear after undergoing arthroscopic rotator cuff repair were included in this study. All the patients were dichotomously classified into the satisfactory or dissatisfactory groups according to the patients' self-classifications. CTA was used to assess the attachment status of the footprint, detect retear on the medial side of the footprint of the repaired cuff, and determine the retear size. Demographic factors, including sex, age, occupation, dominant upper extremity, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker's compensation status, and functional shoulder score, were investigated. RESULTS: Thirty-nine patients were classified into the satisfactory group and 11 patients were classified into the dissatisfactory group. There were no differences in age, sex, occupation, dominant hand, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker's compensation, and duration of follow-up between the two groups. However, the postoperative American Shoulder and Elbow Surgeon (ASES) score (P < 0.01), visual analog scale (VAS) pain level (P < 0.01), anteroposterior (AP) length (P < 0.01), and area of the retear site (P < 0.01) were significantly different. CONCLUSION: The AP length and area of the retear site estimated using CTA were confirmed as the significant risk factors for dissatisfaction. However, the type of repaired rotator cuff judged by the attachment status of the footprint did not correlate with patient satisfaction. In addition, the postoperative VAS pain scale and ASES score was correlated with patient satisfaction.

Predictors of infraspinatus muscle degeneration in individuals with an isolated supraspinatus tendon tear.

OBJECTIVE: Determine the demographic and clinical factors that predict infraspinatus muscle degeneration in individuals with an isolated supraspinatus tendon tear. MATERIALS AND METHODS: A retrospective analysis was performed using the medical records of patients who had a shoulder MRI interpreted by 1 of 3 fellowship-trained musculoskeletal radiologists since the implementation of a standardized MRI 3 T protocol within our healthcare system. Demographic (e.g., age, sex) and clinical data (e.g., tear size, muscle degeneration, co-morbidities) were collected. Patients with an isolated supraspinatus tendon tear (n = 121) were assigned to one of two groups based on whether any infraspinatus muscle degeneration was present. Logistic regression was used to assess the univariate relationships between infraspinatus muscle degeneration and patient and clinical data, while least absolute shrinkage and selector operator (LASSO) logistic regression was used to assess the multivariable relationship. RESULTS: Of the patients with an isolated supraspinatus tendon tear, 16.5% had evidence of infraspinatus muscle degeneration. The presence of infraspinatus muscle degeneration was independently associated with cardiovascular disease (P = 0.01), supraspinatus muscle degeneration (P < 0.01), and subscapularis muscle degeneration (P = 0.01). When the multivariable relationship is assessed, supraspinatus muscle degeneration emerged as the only variable of significant importance for detecting infraspinatus muscle degeneration (specificity: 87.1%, sensitivity: 80.0%). CONCLUSION: Infraspinatus muscle degeneration is not uncommon in individuals with an isolated supraspinatus tear and is most associated with concomitant supraspinatus muscle degeneration. These findings highlight the need for clinicians to specifically assess the status of each rotator cuff muscle, even when the tendon itself is intact.

Delamination of rotator cuff tears impairs healing after repair: a systematic review and meta-analysis.

PURPOSE: To compare the clinical outcomes and retear rates after rotator cuff repair (RCR) between delaminated and non-delaminated tears. METHODS: This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines using the PubMed, Cochrane Library, the Web of Science and Embase databases. Only articles on arthroscopic RCR with clinical outcome scores and data on the number of rotator cuff retears and complete healing were included. This study's relevant data were extracted and statistically analyzed. The methodological index for nonrandomized studies was used to assess the risk of bias in the included studies. After conducting a heterogeneity test and sensitivity analysis to determine whether the samples were heterogeneous, the study also detected publication bias. A sub-group test was used to evaluate the influences of the imaging follow-up period on retear rates. RESULTS: Ten eligible articles were identified with 2,061 patients (925 in the delaminated group and 1,136 in the non-delaminated group). The meta-analysis demonstrated that delamination was significantly associated with higher retear rates (P = 0.026; odds ratio = 1.873, 95% confidence interval 1.079-3.252; I2 = 51.6%) with an imaging follow-up period of > 1 year and lower rates of complete healing (P = 0.036; odds ratio = 0.659, 95% confidence interval 0.446-0.973; I2 = 9.0%) in patients after rotator cuff repair. However, no significant differences were observed between the two groups based on American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, external rotation, internal rotation, or forward elevation. CONCLUSIONS: This meta-analysis found that delamination was significantly associated with higher retear rates with imaging follow-up period of > 1 year, and lower rates of complete healing. In addition, the preoperative and postoperative clinical scores and shoulder joint range of motion were similar between patients with delaminated and non-delaminated tears. LEVEL OF EVIDENCE: Level IV.

A pilot randomised controlled trial assessing standard versus dermal patch-augmented rotator cuff repair found no adverse effects and suggest future trials need a minimum of 150 patients.

PURPOSE: The aims of this pilot randomised controlled trial (RCT) were to assess the safety and efficacy of a human dermal allograft patch and assess the feasibility of a future RCT comparing retear rate and functional outcome 12 months following standard and augmented double-row rotator cuff repair. METHODS:  A pilot RCT was conducted among patients undergoing arthroscopic repair of rotator cuff tear measuring between 1 and 5 cm. They were randomised to either augmented (double-row repair with human acellular dermal patch) or standard (double-row repair only). The primary outcome was rotator cuff retear determined on MRI scan at 12 months using the Sugaya's classification (grade 4 or 5). All adverse events were recorded. Functional assessment was performed at baseline and 3, 6, 9, and 12 months post-surgery using clinical outcome scores. Safety was assessed by complications and adverse effects, and feasibility by recruitment, follow-up rate and proof of concept statistical analyses of a future trial. RESULTS: Between 2017 and 2019, 63 patients were considered for inclusion. Twenty-three patients were excluded, leaving 40 patients (20 per group) in the final study population. The mean tear sizes were 3.0 cm in the augmented and 2.4 cm in the standard group. There was one adhesive capsulitis in the augmented group, with no other adverse events. Retear was observed in 4/18 (22%) of patients in the augmented and 5/18 (28%) in the standard group. In both groups, functional outcome improved significantly which was clinically meaningful for all scores, with no difference between groups. Retear rate increased with tear size. Future trials are feasible but need a minimum total sample size of 150 patients. CONCLUSION:  Clinically meaningful improved function without adverse effects was found with human acellular dermal patch-augmented cuff repairs. LEVEL OF EVIDENCE: Level II.

Older age and higher body mass index are independent risk factors for tendon healing in small- to medium-sized rotator cuff tears.

PURPOSE: Many previous research efforts have been made to identify prognostic factors for rotator cuff healing. However, majority of these studies were conducted with heterogeneous cohorts consisted of different tear characteristics. Healing properties of a rotator cuff tear may differ depending on tear characteristics such as tear size or fatty infiltration. Therefore, studies with subgroups confined by these variables may reflect more accurate results. This study aims to investigate predictive factors for rotator cuff healing in a subgroup with small- to medium-sized tears without significant fatty infiltration. METHODS: This retrospective case-control study was conducted with 94 patients with small- to medium-sized rotator cuff tears. Mean age of patients was 56.0 ± 9.0 years and mean follow-up duration was 38.3 ± 8.1 months. Post-operative magnetic resonance imaging assessment showed that there were 75 (79.8%) successfully healed repairs and 19 (20.2%) healing failures. Age, gender, hand dominancy, body mass index (BMI), smoking habit, diabetes, corticosteroid injection, baseline clinical status, duration of surgery and biceps procedure were variables evaluated as predictive factors. RESULTS: Both study groups showed significant improvement from baseline regarding clinical outcome measures (p < 0.05). However, successfully healed patients had significantly higher post-operative functional scores and lower pain scores (p < 0.05). The univariate analysis revealed that healing was significantly affected by age (p = 0.004), BMI (p = 0.01) and diabetes (p = 0.03). In the multivariate analysis, age (p = 0.02) and BMI (p = 0.02) were found to be significant independent factors for healing. Cutoff values for oldest age and highest BMI were 63 years and 28.1 kg/m2, respectively, for a successful healing according to receiver-operating characteristic curve analysis. CONCLUSION: Healing failure after rotator cuff repair in small- to medium-sized tears is associated with poorer outcomes. Age and BMI are independent predictive factors for healing. A successful repair is more likely in patients younger than 63 years and with BMI less than 28.1 kg/m2. Surgeons should consider this information during risk assessment, decision making and patient counselling. LEVEL OF EVIDENCE: Level III.

Timing of retears after arthroscopic rotator cuff repair and associated factors: a retrospective analysis.

BACKGROUND: Retear after arthroscopic rotator cuff repair (ARCR) remains a complication of important concern. Few reports have evaluated retear timing and its associated patient characteristics in large cohorts. This study aimed to investigate retear timing and patient characteristics and factors associated with this parameter. METHODS: Of the 638 consecutive shoulders that underwent ARCR from August 2009 to November 2019, shoulders with retear complication within 1 year of surgery were included. Retears were defined as type IV or V of the Sugaya's classification, and magnetic resonance imaging was performed at 6 weeks, 3 months, 6 months, and 1 year after surgery. The distribution of patients with retears at the timing of retears was investigated. In addition, patients with retears were classified into the following two groups: early group with retears occurring at 6 weeks and 3 months postoperatively or late group with retears occurring between 6 months and 1 year postoperatively. Associated factors such as sex, age, tear size, pre and postoperative range of motion, surgical technique, and clinical outcome between the two groups were investigated. RESULTS: The 41 shoulders with retears were divided into four groups: 1) within 6 weeks after surgery (n = 9, 22.0%), 2) 6 weeks-to 3 months after surgery (n = 19, 46.3%), 3) 3-6 months after surgery (n = 11, 26.8%), and 4) 6 months-1 year after surgery (n = 2, 4.9%). In addition, there were significantly larger retear sizes in the Sugaya's classification in the early group compared to the late group (P = .013), while there were significantly more males in the late group compared to the early group (P = .030). CONCLUSION: The highest retear rate after ARCR was observed from 6 weeks to 3 months after surgery, with equivalent rates within 6 weeks and from 3 months to 6 months after surgery.

An evaluation of shear wave elastographic characteristics of the supraspinatus tendon after rotator cuff repair.

BACKGROUND: The main complication of rotator cuff repair is retear, which is most common in older patients and patients with greater tear sizes. However, it is unknown why these factors are associated with increased rates of retear. The aim of this study was to determine whether the factors associated with rotator cuff retear (age, tear size, sex, history of trauma, and duration of symptoms) are also associated with decreased mechanical stiffness of the supraspinatus tendon after repair, as assessed by shear wave elastography. METHODS: This was a prospective study of 50 patients undergoing primary rotator cuff repair. A sonographer conducted shear wave elastography ultrasound in all patients at 1, 6, 12, 26, and 52 weeks after repair. The shear wave velocity of the supraspinatus tendon was measured at the tendon-bone interface, 3 mm medial to the interface, and 6 mm medial to the interface. A multiple linear regression analysis was performed with calculation of Cohen F2 values to determine the factors that independently affected supraspinatus tendon stiffness postoperatively. RESULTS: For every decade increase in age, the shear wave velocity of the supraspinatus tendon decreased by 0.5 m/s (P = .004). Greater tear size correlated with reduced supraspinatus shear wave velocity (P < .03 at 6 weeks). Male patients had greater supraspinatus tendon stiffness than female patients (8.2 m/s vs. 6.9 m/s, P = .04). Tendons in patients with a history of trauma were approximately 16% stiffer postoperatively than those in patients with no trauma history (P < .001). Duration of symptoms had no impact on the mechanical stiffness of the supraspinatus tendon. CONCLUSION: Older age, larger tear size, female sex, and nontraumatic tear causation were independently associated with reduced shear wave velocity of the supraspinatus tendon postoperatively. The findings of our study correlate with the results of cohort studies assessing the influence of these variables on rotator cuff retear rates, suggesting that the mechanical stiffness of the supraspinatus tendon, as assessed by shear wave elastography, may have an important association with a successful repair.

Association of obesity with high retears and complication rates, and low functional scores after rotator cuff repair: a systematic review and meta-analysis.

BACKGROUND: Obesity influences the outcomes of orthopedic surgeries such as total knee arthroplasty and spinal surgery. However, the effect of obesity on the outcomes of rotator cuff repair is unknown. This systematic review and meta-analysis aimed to examine the effect of obesity on rotator cuff repair outcomes. METHODS: PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched to identify relevant studies published from their inception till July 2022. Two reviewers independently screened titles and abstracts using the specified criteria. Articles were included if they indicated the effect of obesity on rotator cuff repair and the related outcomes after surgery. Review Manager 5.4.1 software was used to perform statistical analysis. RESULTS: Thirteen articles involving 85,497 patients were included. Obese patients had higher retear rates than nonobese patients (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.23-5.41, P = .01), lower American Shoulder and Elbow Surgeons scores (mean difference [MD]: -3.59, 95% CI: -5.45 to [-1.74]; P = .0001), higher visual analog scale for pain (mean difference: 0.73, 95% CI: 0.29-1.17; P = .001), higher reoperation rates (OR 1.31, 95% CI 1.21-1.42, P < .00001), and higher rates of complications (OR 1.57, 95% CI 1.31-1.87, P = .000). Obesity did not affect the duration of surgery (MD: 6.03, 95% CI: -7.63 to 19.69; P = .39) or external rotation of the shoulder (MD: -1.79, 95% CI: -5.30 to 1.72; P = .32). CONCLUSION: Obesity is a significant risk factor for retear and reoperation after rotator cuff repair. Furthermore, obesity increases the risk of postoperative complications and leads to lower postoperative American Shoulder and Elbow Surgeons scores and higher shoulder visual analog scale for pain.

Work-related outcomes of revision rotator cuff repair for patients receiving workers' compensation.

BACKGROUND: Workers' compensation (WC) patients are susceptible to poorer outcomes following primary rotator cuff repair (RCR). Failure of structural healing can explain some poor results, and outcomes of revision RCR in this population are unknown. METHODS: A retrospective review was performed of individuals receiving WC who underwent arthroscopic revision RCR with or without dermal allograft augmentation at a single institution between January 2010 and April 2021. Preoperative magnetic resonance imaging (MRI) scans were assessed for rotator cuff tear characteristics, Sugaya classification, and Goutallier grade. Postoperative imaging was not routinely obtained unless for continued symptoms or reinjury. Primary outcome measures included return-to-work status, reoperation, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numeric Evaluation (SANE) scores. RESULTS: Twenty-seven shoulders (25 patients) were included. The population was 84% male, with a mean age of 54 years; 67% were manual laborers, 11% sedentary workers, and 22% with a mixed profession. Average follow-up was 35.4 months. Fifteen patients (56%) returned to work at full-duty status. Six (22%) returned to work with permanent restrictions. Six (22%) were unable to return to work in any capacity. Thirty percent of all patients and 35% of manual laborers changed occupation following revision RCR. Mean time to return to work was 6.7 months. Overall, symptomatic rotator cuff retear was found in 13 patients (48%). Reoperation rate after revision RCR was 37% (10 cases). Among patients who did not undergo reoperation, mean ASES scores improved from 37.8 to 69.4 at final follow-up (P < .001). Mean SANE scores only improved marginally from 51.6 to 57.0 (P = .61). No statistically significant correlation was found between preoperative MRI findings and outcome measures. CONCLUSION: Workers' compensation patients demonstrated fair improvements in outcome scores after revision RCR. Although some patients are able to return to full duty, nearly half were either unable to return or returned with permanent restrictions. These data are helpful for surgeons when counseling patients about expectations and return to work after revision RCR in this challenging population.