Patients with diabetes mellitus (DM) have more than double the higher risk of tendon retear after arthroscopic rotator cuff repair, according to a new study.
Diabetics 2x Risk of Tendon Retear After Rotator Cuff Repair
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“Retear of a repaired rotator cuff tendon is an important concern for shoulder surgeons. Many factors contribute to the healing rate of repaired rotator cuff tendons, and DM is one of them,” the researchers wrote.
Diabetes “potentially impairs connective tissue healing and reduces tissue biomechanical properties,” however whether it leads to a higher retear rate of the rotator cuff has remained inconclusive, the researchers wrote.
This new study, “Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis,” published online on November 5, 2020 in the Orthopaedic Journal of Sports Medicine, sought to determine if it is true that patients with diabetes mellitus have a higher tendon retear risk after arthroscopic rotator cuff repair.
The researchers conducted a systematic review of studies in the Web of Science, PubMed, and Embase databases, and identified five that met the inclusion criteria: that they were written in the English language, included patients undergoing arthroscopic rotator cuff repair surgeries, reported the number of patients with and those without diabetes mellitus, and reported the number of rotator cuff retears.
The five studies included 1,065 patients: 207 with diabetes and 858 without it. According to pooled analysis, patients with diabetes did have a higher tendon retear risk than those without the metabolic disease (RR, 2.25; 95% CI, 1.14-4.45; p = .02).
The researchers wrote, “Patients with diabetes mellitus have a 2.25 times higher risk of tendon retear after arthroscopic rotator cuff repair compared with patients without diabetes mellitus.”
They acknowledged, however, that their study had several limitations, including the fact that the number of studies included was small. Further research will be needed to confirm these findings, they said.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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