Factors Predicting Rotator Cuff Tears that are at Risk for Recurrence Tearing at the Time of Surgery
Once the rotator cuff is repaired what are the chances of a tear recurring? There have been multiple studies completed to verify risk factors for recurrence of re-tearing of the surgically repaired tendon.
Surgical reconstructed is recommended on symptomatic patients that have full thickness tears and have partial thickness tears that involve over 50% of the tendon. One of the most common postoperative complications in reference to rotator cuff surgery is a recurrent tear.
Even after surgical reconstruction the rotator cuff can re-tear. There have been studies reporting recurrent tear rates from 11 to 94%. What are the risk factors that would indicate a surgically repaired rotator cuff could re-tear? Risk factors that have been identified in prior studies are: large tear size measuring from anterior to posterior in addition to medial and lateral tear size ( retraction distance) , surface area of the tear size, older age of the patient, the existence of fatty replacement of muscle , presence of muscle atrophy and quality of the torn tendon.
The above factors have been reported in smaller sized studies typically under 200 patients. The biggest study to date with the most amount of patients was reported in the May, 2014 issue of the American Journal of Sports Medicine. The study was led by Brian Le MD from the University of South Wales, Sydney, Australia. Their study included 1,000 consecutive patients who it undergone a primary rotator cuff repair by a single surgeon using arthroscopic technique.
Six months after the rotator cuff surgery an ultrasound was completed to assess the repair integrity. The authors found that the most important factor in predicting recurrent tearing of the rotator cuff was the size of the rotator cuff tear at the index surgery. The research team also found a strong relationship between recurrence rates in patients who had poor tissue quality, poor intra operative tendon immobility and had a second surgical procedure performed in the shoulder at the time of the rotator cuff tear.
In addition, the researchers found that a patient’s age at the time of rotator cuff surgery was a strong independent predictor of recurrent tear rates, with increasing age linked to increasing likelihood. When comparing the rotator cuff tear size from side to side versus the distance the tear was retracted, they found that the side to side tear size was more important predicting recurrent tearing rates then the amount of retraction at the time of surgery.
When discussing rotator cuff surgery and repairs with your patient, or if you are patient about to undergo a rotator cuff repair, there is a risk of recurrent tearing, especially if you are older than age 65 and a patient with a large tear greater than 3 cm.