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Increased HbA1c Levels in Diabetics During the Postoperative 3-6 Months After Rotator Cuff Repair Correlated With Increased Retear Rates

  • Myung Seo Kim
    Affiliations
    Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea

    College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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  • Sung Min Rhee
    Affiliations
    Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea

    College of Medicine, Kyung Hee University, Seoul, Republic of Korea
    Search for articles by this author
  • Nam Su Cho
    Correspondence
    Address correspondence to Nam Su Cho, M.D., Department of Orthopedic Surgery, Cheil Orthopedic Hospital, 726, Yeongdong-daero, Gangnam-gu, Seoul 06075, Republic of Korea.
    Affiliations
    Department of Orthopedic Surgery, Cheil Orthopedic Hospital, Seoul, Republic of Korea
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      Purpose

      To evaluate whether glycemic control affects the integrity of the repaired rotator cuff during the postoperative healing period after arthroscopic double-row suture bridge rotator cuff repair (RCR)

      Methods

      We retrospectively reviewed patients with diabetes mellitus (DM) who underwent arthroscopic double-row suture bridge RCR at our institution between March 2016 and November 2019. We included the patients who evaluated for serum glycosylated hemoglobin (HbA1c) levels within 1 month before and 3–6 months after surgery. Magnetic resonance imaging was conducted 6 months after surgery to evaluate the integrity of the repaired cuff tendon. Patients were categorized into two groups based on comparison between preoperative and postoperative HbA1c values: Group I (increased postoperative HbA1c) and Group D (same or decreased postoperative HbA1c). The correlation between preoperative/postoperative HbA1c, HbA1c increase/same or decrease (during the healing period), and post-RCR integrity was evaluated, including various demographic and radiologic factors.

      Results

      A total of 103 patients were analyzed, group I was 47, and group D was 56, respectively. The retear rate of 51.1% (24/47) in Group I was significantly higher than 14.3% (8/56) in Group D (P < .001). HbA1c levels measured 3-6 months after surgery (mean: 6.9; 95% CI: 6.6–7.3 vs mean: 6.5; 95% CI: 6.3–6.7, P = .034), and the proportion of group I and group D were significantly different (75%/25% vs 32.4%/67.6%, P < .001) between the retear and healing groups. Multivariable logistic regression analysis identified increased HbA1c as an independent risk factor for retear (odds ratio: 5.402; 95% CI: 2.072–14.086; P < .001).

      Conclusions

      The glycemic control within 3-6 months after surgery when the healing process of the tendon was in progress had a significant effect on retear rate. In particular, the retear rate was higher when the HbA1c level increased at postoperative 3-6 months compared to before surgery.

      Level of Evidence

      Retrospective case-control comparative study, Level III.
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