Factors associated with healing failure after early repair of acute, trauma-related rotator cuff tears
(2023) In Journal of Shoulder and Elbow Surgery 32(10). p.2074-2081- Abstract
Background: Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The aim of this study was to identify factors associated with healing failure in previously asymptomatic patients with trauma-related rotator cuff tears treated with early arthroscopic repair. Methods: This study included 62 consecutively recruited patients (23% women; median age, 61 years; age range, 42-75 years) with acute symptoms in a previously asymptomatic shoulder and a magnetic resonance imaging–verified full-thickness rotator cuff tear after shoulder trauma. All patients were offered, and underwent, early arthroscopic repair, during which a biopsy specimen... (More)
Background: Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The aim of this study was to identify factors associated with healing failure in previously asymptomatic patients with trauma-related rotator cuff tears treated with early arthroscopic repair. Methods: This study included 62 consecutively recruited patients (23% women; median age, 61 years; age range, 42-75 years) with acute symptoms in a previously asymptomatic shoulder and a magnetic resonance imaging–verified full-thickness rotator cuff tear after shoulder trauma. All patients were offered, and underwent, early arthroscopic repair, during which a biopsy specimen was harvested from the supraspinatus tendon and analyzed for signs of degeneration. Of the patients, 57 (92%) completed 1-year follow-up and underwent assessment of repair integrity on magnetic resonance images according to the Sugaya classification. Risk factors for healing failure were investigated using a causal-relation diagram where age, body mass index, tendon degeneration (Bonar score), diabetes mellitus, fatty infiltration (FI), sex, smoking, tear location regarding integrity of the rotator cable, and tear size (number of ruptured tendons and tendon retraction) were included and analyzed. Results: Healing failure at 1 year was identified in 37% of patients (n = 21). A high degree of FI of the supraspinatus muscle (P = .01), a tear location including disruption of rotator cable integrity (P = .01), and old age (P = .03) were associated with healing failure. Tendon degeneration as determined by histopathology was not associated with healing failure at 1-year follow-up (P = .63). Conclusion: Older age, increased FI of the supraspinatus muscle, and a tear including disruption of the rotator cable increased the risk of healing failure after early arthroscopic repair in patients with trauma-related full-thickness rotator cuff tears.
(Less)
- author
- Aagaard, Knut E. LU ; Lunsjö, Karl LU ; Adolfsson, Lars ; Frobell, Richard LU and Björnsson Hallgren, Hanna
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- healing failure, Level I, Prognosis Study, Prospective Cohort Design, risk factors, rotator cable, Rotator cuff tear, subacute repair, tendon degeneration, tendon healing
- in
- Journal of Shoulder and Elbow Surgery
- volume
- 32
- issue
- 10
- pages
- 8 pages
- publisher
- Mosby-Elsevier
- external identifiers
-
- pmid:37178969
- scopus:85164984931
- ISSN
- 1058-2746
- DOI
- 10.1016/j.jse.2023.03.027
- language
- English
- LU publication?
- yes
- id
- 0b2f4fda-be35-46fd-805c-6a654b3e34bd
- date added to LUP
- 2023-10-03 11:45:18
- date last changed
- 2024-11-02 21:48:08
@article{0b2f4fda-be35-46fd-805c-6a654b3e34bd,
abstract = {{<p>Background: Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The aim of this study was to identify factors associated with healing failure in previously asymptomatic patients with trauma-related rotator cuff tears treated with early arthroscopic repair. Methods: This study included 62 consecutively recruited patients (23% women; median age, 61 years; age range, 42-75 years) with acute symptoms in a previously asymptomatic shoulder and a magnetic resonance imaging–verified full-thickness rotator cuff tear after shoulder trauma. All patients were offered, and underwent, early arthroscopic repair, during which a biopsy specimen was harvested from the supraspinatus tendon and analyzed for signs of degeneration. Of the patients, 57 (92%) completed 1-year follow-up and underwent assessment of repair integrity on magnetic resonance images according to the Sugaya classification. Risk factors for healing failure were investigated using a causal-relation diagram where age, body mass index, tendon degeneration (Bonar score), diabetes mellitus, fatty infiltration (FI), sex, smoking, tear location regarding integrity of the rotator cable, and tear size (number of ruptured tendons and tendon retraction) were included and analyzed. Results: Healing failure at 1 year was identified in 37% of patients (n = 21). A high degree of FI of the supraspinatus muscle (P = .01), a tear location including disruption of rotator cable integrity (P = .01), and old age (P = .03) were associated with healing failure. Tendon degeneration as determined by histopathology was not associated with healing failure at 1-year follow-up (P = .63). Conclusion: Older age, increased FI of the supraspinatus muscle, and a tear including disruption of the rotator cable increased the risk of healing failure after early arthroscopic repair in patients with trauma-related full-thickness rotator cuff tears.</p>}},
author = {{Aagaard, Knut E. and Lunsjö, Karl and Adolfsson, Lars and Frobell, Richard and Björnsson Hallgren, Hanna}},
issn = {{1058-2746}},
keywords = {{healing failure; Level I; Prognosis Study; Prospective Cohort Design; risk factors; rotator cable; Rotator cuff tear; subacute repair; tendon degeneration; tendon healing}},
language = {{eng}},
number = {{10}},
pages = {{2074--2081}},
publisher = {{Mosby-Elsevier}},
series = {{Journal of Shoulder and Elbow Surgery}},
title = {{Factors associated with healing failure after early repair of acute, trauma-related rotator cuff tears}},
url = {{http://dx.doi.org/10.1016/j.jse.2023.03.027}},
doi = {{10.1016/j.jse.2023.03.027}},
volume = {{32}},
year = {{2023}},
}