Repair tension during arthroscopic rotator cuff repair may predict rotator cuff integrity
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Published results showed measuring tension during arthroscopic rotator cuff repair may effectively predict rotator cuff integrity, with a correlation between intraoperative repair tension and tear size in the mediolateral direction.
Researchers measured intraoperative repair tension according to Davidson’s method in 120 patients with medium or large rotator cuff tears who underwent arthroscopic rotator cuff repair from May 2014 to June 2017 and had a minimum of 6 months follow-up. Researchers used Pearson and Spearman correlation coefficient tests to evaluate correlation of repair tension with preoperative factors. Researchers also performed logistic regression analysis using intraoperative factors, including repair tension, to identify independent predictors of retear after arthroscopic rotator cuff repair. They also used the receiver operating characteristic curve to determine the cutoff value of repair tension for retear.
Results showed patients had a mean repair tension of approximately 26.6 N and 24.2% of shoulders experienced retear. Researchers found tear size in the mediolateral and anteroposterior directions, DeOrio and Cofield’s classification, geometric classification and fatty infiltration of supraspinatus and infraspinatus had a significant correlation with repair tension. However, only tear size in the mediolateral direction was identified as an independent predictor of repair tension in multivariate logistic regression analysis, according to results. Significant factors affecting rotator cuff integrity after arthroscopic rotator cuff repair included repair tension and geometric classification, according to results of the logistic regression analysis. In receiver operating characteristic curve analysis, researchers found the cutoff value of repair tension of large to massive tears for retear to be 35.6 N.
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Ronald A. Navarro, MD, FAAOS, FAOA
Of primary concern to orthopedic surgeons and patients with rotator cuff disease alike is the occurrence of retear following arthroscopic rotator cuff repair. Along with preoperative risk factors, such as tear size and tear morphology, intraoperative tension has been implicated as another prognostic factor. Yoshitsugu Takeda, MD, PhD, and colleagues demonstrate the significant association of higher tension during arthroscopic rotator cuff repair with rotator cuff integrity post-procedure and add to a growing body of literature seeking to rigorously quantify markers predictive of arthroscopic rotator cuff repair complications.
Semantically, their work might better state that an upper limit of repair tension can predict failure rather just measuring tension. Their findings may serve as a valuable educational tool during preoperative informed consent discussions regarding the integrity of potential repair. Surgeons who add this to their toolbox by measuring tension during arthroscopic rotator cuff repair may gain a greater understanding of each patient’s individualized risk of retear and impact rehabilitation protocols.
A holy grail from this work could be the hope that image modelling of MRI could predict tension required to effect complete repair a priori as surgeons may not find intraoperative tension checks practical.
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