Purpose
This study aimed to examine the correlation of repair tension during arthroscopic
rotator cuff repair (ARCR) with preoperative factors and to evaluate whether measuring
tension during ARCR is effective for predicting rotator cuff integrity after ARCR.
Methods
Patients who underwent ARCR from May 2014 to June 2017 were enrolled in this study.
Inclusion criteria were patients with medium or larger-sized tears and with a minimum
of 6 months’ follow-up. Patients with a partial repair were excluded. Intraoperative
repair tension was measured according to Davidson’s method. Correlation of repair
tension with preoperative factors was evaluated with Pearson and Spearman correlation
coefficient tests. Logistic regression analysis was performed on intraoperative factors,
including repair tension, to identify independent predictors of retear after ARCR.
Receiver operating characteristic (ROC) curve was used to determine the cutoff value
of repair tension for retear.
Results
One-hundred twenty patients met the inclusion criteria. Mean repair tension was 26.6 ± 12.6
N, and retear was found in 29 shoulders (24.2%). Among the preoperative factors, tear
size in the mediolateral (P < .001) and anteroposterior (P < .001) directions, DeOrio and Cofield’s classification (P <0.001), geometric classification (P <.001), and fatty infiltration of supraspinatus (P = .006) and infraspinatus (P = .003) were significantly correlated with repair tension. However, multivariable
logistic regression analysis identified only tear size in the mediolateral direction
as an independent predictor of repair tension (P = .036). Logistic regression analysis showed that repair tension (P = .02) and geometric classification (P < .001) are significant factors affecting rotator cuff integrity after ARCR. ROC
curve analysis showed the cutoff value of repair tension of large to massive tears
for retear to be 35.6 N.
Conclusion
This study demonstrated that intraoperative repair tension is strongly correlated
with tear size in the mediolateral direction based on preoperative magnetic resonance
imaging and that measuring tension during ARCR is effective for predicting rotator
cuff integrity after ARCR.
Level of Evidence
Level IV, prognostic study.
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Article info
Publication history
Published online: April 19, 2021
Accepted:
March 30,
2021
Received:
July 1,
2020
Footnotes
See commentary on page 2743
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America
