Search Filters

  • Presentation Format
  • Media Type
  • Diagnosis / Condition
  • Diagnosis Method
  • Patient Populations
  • Treatment / Technique

The factors influencing postoperative cuff integrity of arthroscopic rotator cuff repair combined with muscle advancement for massive rotator cuff tear

The factors influencing postoperative cuff integrity of arthroscopic rotator cuff repair combined with muscle advancement for massive rotator cuff tear

Yasuhiko Sumimoto, MD, JAPAN Shin Yokoya, MD, PhD, JAPAN Yohei Harada, MD, PhD, JAPAN Nobuo Adachi, MD, PhD, JAPAN

Hiroshima University Hospital, Hiroshima, Hiroshima, JAPAN


2021 Congress   Abstract Presentation   5 minutes   Not yet rated

 

Anatomic Location

Diagnosis / Condition

Treatment / Technique

Anatomic Structure

Diagnosis Method

MRI

Sports Medicine

This media is available to current ISAKOS Members, Global Link All-Access Subscribers and Webinar/Course Registrants only.

Summary: ISP retraction and TM atrophy may be the key factors for predicting postoperative cuff integrity when arthroscopic rotator cuff repair combined with muscle advancement for massive rotator cuff tear is performed.


Introduction

It is well known that the failure rate after arthroscopic rotator cuff repair (ARCR) in the case of massive rotator cuff tear (mRCT) is high, and that the treatment is often difficult. We have reported that ARCR combined with muscle advancement (MA) can be expected to reduce the failure rate of mRCT treatment. Nevertheless, failure is an inevitable risk, which has obvious negative implications for the clinical outcomes, so it is important to reveal what the potential risk factors are. Hence, our aim in this study was to research the factors that can influence postoperative cuff integrity of ARCR combined with MA for mRCT.

Methods

From October 2011 to September 2020, we examined 68 patients who underwent ARCR with MA for mRCT, and postoperative MRI enabled us to evaluate whether cases healed or failed after surgery. There were 40 males and 28 females, and the average age at surgery was 66.6 ± 8.6 (39-81) years. We passed nylon thread through the supraspinatus tendon (SSP) and infraspinatus tendon (ISP), and pulled it with a tension meter at 30N in a 30 degrees’ abduction position. MA was performed in cases where full coverage of the footprint could not be achieved by the cuff stumps. We evaluated patient background {age, sex, diabetes mellitus (DM)}, preoperative clinical scores (Constant shoulder score, University of California at Los Angeles Shoulder score, Numerical Rating Scale), preoperative X-ray findings (acromiohumeral interval, critical shoulder angle), preoperative MRI findings (rotator cuff retraction size, fatty infiltration, muscle atrophy), and intraoperative findings (Subscapularis tendon injury, long head biceps tendon injury, with or without a polyglycolic acid sheet). These items were divided into the healed group and failed group (Sugaya classification type IV and V were defined as failure by postoperative MRI). Univariate and multivariate logistic regression analysis was performed, and P <0.05 was considered as significant.

Results

Univariate analysis showed the DM, SSP and ISP retraction size, SSP fatty infiltration, global fatty degeneration index, and teres minor muscle atrophy (TM atrophy) to be significantly more pronounced in the failed group than in the healed group. Multivariate analysis showed the ISP retraction size and TM atrophy to be significantly higher in the failed group than in the healed group.

Conclusion

We investigated the factors influencing postoperative cuff integrity of ARCR combined with MA for mRCT. Multivariate analysis showed ISP retraction and TM atrophy to be significantly higher in the failed group than in the healed group. These factors may be crucial for the accurate prediction of postoperative cuff integrity when ARCR is combined with MA for mRCT.


More ISAKOS 2021: Global Content