3 Critical Risks for Poor Rotator Cuff Outcomes

Researchers have identified smoking, female sex, and retears of the same or larger size than the initial tear as independent risk factors for poor clinical outcomes after a rotator cuff retear.

In the study, “Poor Prognostic Factors in Patients With Rotator Cuff Retear,” published online on April 2, 2021 in the Orthopaedic Journal of Sports Medicine, they analyzed data on patients with a retear after primary arthroscopic rotator cuff repair to determine the risk factors for poor clinical outcomes after a retear.

The researchers wrote, “Because of several studies with contrasting views on retears, it is difficult to determine whether revision surgery or nonoperative management should be performed if a retear occurs after arthroscopic rotator cuff repair. If the clinical course and prognosis after a retear can be predicted, better treatment will be provided to patients with retears.”

The study enrolled 45 patients who initially underwent repair between January 2011 and December 2016 and then experienced retear. All procedures were performed by the same shoulder surgeon.

Patient follow-up occurred at 2 weeks, 4 weeks, 3 months, 6 months, 1 year, and 2 year postoperatively.

Revision surgery was recommended to the patient who had pain and discomfort at 1-year follow-up.

Overall, 31 patients had good outcomes while 14 patients did not.

“Both the good and the poor outcome groups showed that clinical scores significantly improved at the time of the retear diagnosis, but the final scores were maintained or worse compared with scores at the time of the retear diagnosis,” they wrote.

“Final range of motion (ROM), except external rotation in the good outcome group, was worse or had no significant change compared with ROM at the time of the retear diagnosis.”

Current smoking odds ratio [OR], 45.580 [95% CI, 3.014-689.274]; p = .006), female sex (OR, 32.774 [95% CI, 2.433-441.575]; p = .009), and retears of the same or larger size than the initial tear (OR, 10.261 [95% CI, 1.544-68.202]; p = .016) all showed a higher OR for poor clinical outcomes after a retear.

“Smoking, female sex, and retears of the same or larger size than the initial tear were independent risk factors for poor clinical outcomes after a rotator cuff retear. Final clinical scores and ROM were similar or worse compared with the scores and ROM at the time of the retear diagnosis. Therefore, revision surgery should be actively considered in female patients or those who smoke with poor clinical outcomes and a larger retear size than the preoperative tear size at the time of the retear diagnosis,” the researchers wrote.