Does a High HbA1c Equal a High Rotator Cuff Retear Rate?

As we know, patients with diabetes who undergo rotator cuff repair have higher complication risks. A new study from South Korea has asked the interesting question, is there a dose response curve associated with the severity of diabetes in presenting patients? So, for example, if serum glycosulated hemoglobin level increases during the first three to six months after surgery, does the retear rate change?

The study, “Increased HbA1c Levels in Diabetics During the Postoperative 3-6 Months After Rotator Cuff Repair Correlated With Increased Retear Rates,” was published online in the February 1, 2023 issue of the journal Arthroscopy. The researchers conducted a retrospective review of patients with diabetes mellitus who underwent arthroscopic double-row suture bridge rotator cuff repair at a single institute between March 2016 and November 2019. The primary outcome of the review was to see if glycemic control affected the integrity of the repaired rotator cuff.

They included patients who had their serum glycosylated hemoglobin or HbA1c levels evaluated within the month prior to surgery and three to six months after it. They broke patients down into two groups: those with increased postoperative HbA1c and those with same or decreased levels. All the patients underwent magnetic resonance imaging six months after the surgery.

The research team from Kyung Hee University Hospital enrolled 103 patients in the study: 47 patients had high HbA1c levels and 56 had levels that were the same or lower.

The team found that the retear rate in the first group was 51.1%, almost 4x higher than the rate in the other group—which was 14.3%.

As might be expected, a multivariable logistic regression analysis established HbA1c as an independent risk factor for retear (odds ratio: 5.402; 95% CI: 2.072-14.086; p < .001).

In an accompanying editorial, “Rotator Cuff Repair in Patients With Diabetes: Stricter Glycemic Control for the First 6 Months Is Associated With Better Healing,” Peter N. Chalmers, M.D. and Christopher D. Joyce, M.D., both from the University of Utah, wrote, “Retear rates after arthroscopic rotator cuff repair continue to be unacceptably high. Of the known risk factors for failure of rotator cuff repair, many are nonmodifiable. Poor glycemic control in patients with diabetes in the first 3 to 6 months after arthroscopic rotator cuff repair is associated with a lower healing rate. This represents a modifiable risk factor that we should routinely address in patients’ postoperative rotator cuff repair.”

Study authors included Myung Seo Kim, M.D., Sung Min Rhee, M.D., both from Kyung Hee University Hospital at Gangdon, Seoul, Republic of Korea  and Nam Su Cho, M.D., of Cheil Orthopedic Hospital, Gangnam-gu, Seoul, Republic of Korea.