Summary

Intraoperative repair tension was an independent predictive factor that affected the incidence of retear after arthroscopic rotator cuff repair.

Abstract

Purpose

Intraoperative cuff repair tension plays a significant role on achieving anatomic healing after arthroscopic rotator cuff repair (ARCR). However, only a few studies have correlated intraoperative repear tension with postoperative rotator cuff integrity. Purpose of this study was to evaluate the repair tension as a predictive factor for postoperative rotator cuff integrity.

Methods

This prospective study involved 120 consecutive patients who underwent ARCR from 2014 through 2016. Inclusion criteria were patients with medium or larger sized tear and a minimum of 12 moths follow-up. Patients who had unrepairable tear or partial repair were excluded. Intraoperative repair tension was measured according to the method of Davidson using a tensiometer. Rotator cuff integrity was evaluated with magnetic resonance imaging at 12 months post-surgery. Retear after ARCR was defined as Sugaya type IV and V. Binary regression analysis was performed to analyze the effect of repair tension and preoperative MRI findings (fatty infiltration, tear size and occupation ratio) on the structural integrity after ARCR. To determine the cutoff value for repair tension, receiver operating characteristic curve analysis was performed.

Results

Retear rate was 24.1% (29 shoulders). Repair tension of the retear group (34.7N) was significantly greater than that of the healed group (24.3N)(p<0.001). Binary regression analysis demonstrated that repair tension and occupation ratio of supraspinatus was the independent predictors of retears. Fatty infiltration of supraspinatus and infraspinatus, tear size in mediolateral and anteroposterior direction were not independent predictors. Cutoff value for the repair tension was 26.0N.

Conclusion

This study showed that intraoperative repair tension was an independent predictive factor that affected the incidence of retear. Measuring repair tension may help surgeons determine proper surgical procedure during surgery.