ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper

 

Revision Rotator Cuff Repair Versus Primary Repair For Large To Massive Tears Involving Posterosuperior Cuff: Comparison Of Clinical And Radiological Outcomes

Prashant Meshram, MBBS, MS, DNB (Ortho), Lutherville, Maryland INDIA
Bei Liu, MD, Seoul KOREA, REPUBLIC OF
Sang Woo Kim, MD, Seoul KOREA, REPUBLIC OF
Kang Heo, MD, Seoul KOREA, REPUBLIC OF
Joo Han Oh, MD, PhD, Seongnam-Si, Gyeonggi-do KOREA, REPUBLIC OF

Seoul National University Bundang Hospital, Seongnam, Gyeongii Do, KOREA, REPUBLIC OF

FDA Status Cleared

Summary

Revision rotator cuff repair had similar clinical and radiological outcomes to the primary repairs of large to massive posterosuperior tears.

Abstract

Background

Outcomes of revision rotator cuff repair (rRCR) have conflicting results with a retear rate ranging 50 - 90%. Another group of patients who have unpredictable clinical outcomes are those who undergo primary RCR (pRCR) for large to massive rotator cuff tears (mRCT). The purpose of this study was to compare the clinical outcomes in patients with posterosuperior rotator cuff tear who had a rRCR for tear of any size with those who had a pRCR for mRCT.

Methods

Among patients with posterosuperior cuff tear operated between 2010 and 2017, the clinical outcomes of 46 patients who underwent a rRCR were compared to 106 patients who had a pRCR for mRCT. The mean follow-up was 26.4 months (range, 24–81 months). The difference in patient reported outcomes (PROs) at the final follow-up between the comparison groups was evaluated and compared with previously published minimal clinically important difference (MCID) values. Radiological outcome was evaluated using MRI or ultrasonography at a minimum one-year follow-up. To identify the risk factors for poor ASES score, a multivariate linear regression analysis was performed. A multivariate logistic regression analysis was used to assess the risk factors for healing failure.

Results

The patients in each rRCR and pRCR group had a statistically significant and clinically relevant improvement in PROs and ROM when compared from preoperative to postoperative status at the final follow-up. Comparing the PROs at final follow-up between two groups, the pain VAS (2.1 vs. 1.0, P = 0.004), satisfaction VAS (6.9 vs. 8.6, P < 0.001), and ASES score (79.7 vs. 89.8, P = 0.001) in rRCR group were statistically significantly worse than pRCR group, whereas the Constant score (68.0 vs. 67.8, P > 0.05) was not statistically different between two groups. None of the above differences in PROs were clinically significant as they did not exceed the MCID threshold. The ROM in rRCR group was not statistically significant than pRCR group for flexion (158° vs 163°) and external rotation at 90° (85° vs 89°).
The rate of healing failure in the rRCR group was 50% compared with the pRCR group (39%; p=0.194). While comparing PROs within rRCR group, those who had a healing failure at follow up showed significantly worse pain VAS score and ASES score than patients with intact cuff. Risk factors for worse ASES score in patients of rRCR group were healing failure (P=0.043, r=-11.3), lower body mass index (P=0.032, r=1.9), and lower preoperative pain VAS (P=0.038, r=2.3). The risk factors for healing failure in rRCR were preoperative high-grade fatty degeneration (Goutallier grade 3 and 4) of supraspinatus muscle (P=0.026, OR 5.2) and hyperlipidemia (P=0.035, OR 11.8).

Conclusion

Revision rotator cuff repair had similar clinical and radiological outcomes to the primary repairs of large to massive posterosuperior tears. Patients with symptomatic failed rotator cuff repairs having high-grade fatty degeneration of supraspinatus and/or serum hyperlipidemia had a higher likelihood of healing failure after revision repair which was associated with poor functional outcomes. These patients should be considered for an alternative treatment.

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