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Researchers find 17% rotator cuff re-tear rate with predictive equation
Predictive factors for re-tear were anteroposterior and medial-lateral tear length, tear size area and thickness, age and operative time.
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CHICAGO — Australian investigators identified predictors of rotator cuff re-tear and used them to create a formula that help them predict the chances of a re-tear, according to research recently presented at the American Orthopaedic Society for Sports Medicine Specialty Day, here.
“We found that tear sizes were predictive of re-tear,” Brian T. Le, of St. George Hospital, in Sydney, Australia, said during his presentation. “The anterior-posterior tear length was more predictive [of re-tear] than the medial-lateral tear length in our group. We produced a predictive formula to estimate a patient’s risk of re-tear, which involved patient age, tear thickness, tear size and operative time.”
Images: Murrell GAC
Overall, the re-tear rate was 17%, according to Le.
Retrospective study
Le and colleagues retrospectively studied prospectively collected data acquired between 2006 and 2011 for 1,000 patients who underwent arthroscopic rotator cuff (RC) repair and had an ultrasound at 6 months postoperatively and identified 174 patients with a re-tear.
Preoperatively, each patient completed the modified L’Insalata Shoulder Questionnaire and underwent a clinical examination. The primary surgeon recorded parameters of each operation and noted the size of the re-tear. Then the researchers performed a logistic regression analysis to calculate the correlation coefficients.
According to the findings, the predictive factors that negatively correlated with RC re-tear included the following:
- Anteroposterior tear length with a 0.41 correlation coefficient;
- Tear size area with a 0.40 correlation coefficient;
- Medial-lateral tear length with a 0.34 correlation coefficient;
- Tear thickness with a 0.29 correlation coefficient;
- Patient age at surgery with a 0.27 correlation coefficient; and
- Operative time with a 0.18 correlation coefficient.
Using these factors, the researchers developed a predictive equation for re-tear.
Size of anteroposterior tear critical
Researchers found the size of any anteroposterior tear was more predictive of a re-tear than medial-lateral tear size.
“As these [factors] decreased in magnitude, the patient’s risk of re-tear increased,” Le said. “Factors which related to mechanical properties of the tear were more important at predicting re-tear than variables we measured related to patient tissue quality,” he said.
Factors not significantly correlated with re-tear included whether the patient had diabetes, gender, duration of symptoms, which shoulder was affected, preoperative pain and preoperative range of motion.
An 82-year-old patient with post-traumatic shoulder pain to which the researchers applied the predictive formula for re-tear had a RC tear sized 4 cm by 3 cm that took 40 minutes to repair and, based on the equation that Le and colleagues developed, he had a 77% chance of re-tearing his rotator cuff, Le said.
According to Le, the limitations of the study included a retrospective design, the inclusion of a single surgeon at a single center and a short follow-up time of 6 months.
Furthermore, “We did not specifically address clinical outcomes between the two groups,” Le said. – by Renee Blisard Buddle
- References:
- Le B. Paper #16. Presented at: American Orthopaedic Society for Sports Medicine Specialty Day; March 23, 2013; Chicago.
- L’Insalata JC. J Bone Joint Surg Am. 1997;79:738-748.
- For more information:
- Brian T. Le and George A.C. Murrell, MD, PhD, can be reached at Orthopaedic Research Institute, St. George Hospital, Kogarah NSW 2217, Sydney, Australia; emails: brian.le.89@gmail.com, murrell.g@ori.org.au.
Disclosure: Le has no relevant financial disclosures.
Perspective
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Carlos Torrens, MD
Results of this huge study may be helpful in peri-operative decision making as well as to inform the patient after surgery about the risk of re-tear depending on the antero-posterior tear length. Surgeons can also change surgical strategies depending on peri-operative findings. The weaknesses of the study include short follow-up and the lack of information concerning preoperative fatty infiltration of the cuff, which is known to have a strong influence on re-tear rate. It would be of interest if the authors could follow their research by adding some information about preoperative fatty infiltration and how it correlates with tear sizes.
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