Gender and degree of tendon healing are independent predictive factors for clinical outcome in successfully healed rotator cuff tears

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 31; no. 10; pp. 4585 - 4593
• Main Authors: Şahin, Koray, Albayrak, Muhammed Oğuzhan, Şentürk, Fatih, Ersin, Mehmet, Erşen, Ali
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2023; Springer Nature B.V
• Subjects: Body mass; Body mass index; Body size; Classification; Clinical outcomes; Condoms; Decision making; Females; Gender; Healing; Injuries; Magnetic resonance imaging; Medicine; Medicine & Public Health; Orthopedics; Outcome; Patients; Population studies; Predictive factor; Regression analysis; Risk assessment; Rotator cuff; Rotator cuff healing; Rotator cuff tear; Shoulder; Sports Medicine; Tendons; Rotator cuff healing; Rotator cuff tear; Predictive factor; Outcome
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-023-07508-7

Purpose
Arthroscopic rotator cuff repair (aRCR) is a commonly performed procedure and has been reported to be a successful treatment. Successful healing has traditionally been considered to be associated with good outcome; however, knowledge on predictive factors affecting final outcome other than tendon healing is limited. This study aims to investigate predictive factors influencing clinical outcome following aRCR in patients with successfully healed tears.
Methods
This retrospective case–control study was conducted in a single center with 135 patients who had successfully healed tendons based on Sugaya classification (grades I–III) on postoperative magnetic resonance imaging (MRI) scans following aRCR. Clinical outcome measures included Constant–Murley score (CMS), range of motion (ROM), pain score. Various preoperative, intraoperative factors and degree of postoperative tendon healing were assessed to identify independent predictive factors for final clinical outcome.
Results
Mean age of patients was 55.9 ± 9.0 years and mean follow-up duration was 46.8 ± 14.9 months. There were 50 (37%) male and 85 (63.0%) female patients. At final follow-up, mean CMS was 85.7 ± 12.0. Considering mean postoperative CMS and the minimal clinically important difference (MCID) of 10 points for CMS, a cutoff level of 75 points for CMS was set (85–10 = 75) and study population was divided into two study groups (group I, poor outcome, CMS ≤ ;75, and group II, good outcome, CMS > 75). There were 24 (17.8%) patients in group I and 111 (82.2%) patients in group II. Univariate analysis revealed that gender, body mass index (BMI) and degree of tendon healing (Sugaya classification) differed significantly between two groups (
p
 < 0.05). Multivariate logistic regression analysis which was conducted with these variables showed that female gender (odds ratio 3.65) and Sugaya grade III (odds ratio 8.19) were independent predictive factors which were significantly associated with poor outcome (
p
 < 0.05).
Conclusions
This study showed that despite achieving a successful healing, considerable amount of patients (17.8%) have ended up with poor outcome. Female gender and degree of tendon healing were identified as independent predictive factors for poor outcome. These data would help surgeons during decision-making, risk assessment and patient counseling.
Level of evidence
III.