Summary

We evaluated functional and structural outcome in patients with re-tear who had large / massive cuff tears treated by arthroscopic surgery; As a result, preoperative supraspinatus / infraspinatus fatty degeneration with Goutallier stage 3 or more was significantly associated with subsequent tear propagation and worse functional outcomes at the final follow-up.

Abstract

Introduction

Arthroscopic rotator cuff repair (ARCR) produces good clinical outcomes in patients with large or massive cuff tears, although clinical outcomes after re-tear remain controversial. Therefore, the purpose of the present study was to evaluate the functional and structural outcome in patients with re-tear who had large or massive cuff tears treated by arthroscopic surgery.

Methods

Between 2005 and 2015, 196 patients with large or massive rotator cuff tears underwent ARCR. The inclusion criteria were: (1) Those who had large or massive cuff tears repaired by ARCR; (2) those who had complete coverage during surgery; (3) those who were available for magnetic resonance imaging at 3, 6, 12, and 24 months after surgery. Consequently, 39 patients with re-tears were subjects for this study. Functional outcome measures included University of California, Los Angeles (UCLA) score. According to the score at the final follow-up, the patients were divided into 2 groups: Satisfactory group (=28 points, n = 23) and Unsatisfactory group (<28 points, n = 16). Structural outcome measures evaluated by magnetic resonance imaging consisted of tear size and fatty degeneration of the rotator cuff muscles. These outcome measures were evaluated pre- and postoperatively.

Results

The mean UCLA score of all patients significantly improved from 15.5 ± 4.6 points preoperatively to 28.3 ± 6.6 points postoperatively (P = 0.03). There was no significant difference in the mean preoperative UCLA scores between the 2 groups. Multivariate logistic analysis showed that facet in which the tendon was unpreserved (cutoff value: middle facet) and the Goutallier stages of the supraspinatus (SSP) and infraspinatus (ISP) tendons before surgery (cutoff value: stage 2 for each) were significantly associated with worse UCLA score at the final follow-up. In the Satisfactory group, re-tear sizes in the coronal and sagittal plane at postoperative 3 or 6 months were not significantly increased by 24 months after surgery; In contrast, in the Unsatisfactory group, the re-tear size in the sagittal plane significantly increased at 12 / 24 months after surgery (P = 0.03, respectively).

Discussion And Conclusion

Tear propagation in symptomatic or asymptomatic cuff tears are often observed; however, the association with clinical outcome remains controversial. In the present study, the re-tear size in the sagittal plane was significantly increased in the Unsatisfactory group but not in the Satisfactory group. Progressed fatty degeneration of the SSP / ISP, as well as the unpreserved middle facet, were significantly associated with worse functional outcome. Given the data described above, the tear propagation after re-tear may have occurred to the middle facet at which the fatty-degenerated tendons attach, contributing the worse score at the final follow-up.
In conclusion, total UCLA score was significantly improved in patients with re-tear who had large or massive cuff tears treated by arthroscopic surgery; however, preoperative SSP / ISP fatty degeneration with Goutallier stage 3 or more was associated with subsequent tear propagation after re-tear, leading to the worse functional outcome at the final follow-up.