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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References
- Treatment strategy for irreparable rotator cuff tears.Clinics Orthop Surg. 2018; 10: 119-134
- Biceps rerouting for semirigid large-to-massive rotator cuff tears.Arthroscopy. 2021; 37: 2769-2779
- Effect of recombinant human parathyroid hormone on rotator cuff healing after arthroscopic repair.Arthroscopy. 2019; 35: 1064-1071
- Does statin-treated hyperlipidemia affect rotator cuff healing or muscle fatty infiltration after rotator cuff repair?.J Shoulder Elbow Surg. 2021; 30: 2465-2474
- Clinical and structural outcomes after rotator cuff repair in patients with diabetes: A meta-analysis.Orthop J Sports Med. 2020; 82325967120948499
- The influence of diabetes mellitus on clinical and structural outcomes after arthroscopic rotator cuff repair.Am J Sports Med. 2015; 43: 991-997
- High glucose represses the proliferation of tendon fibroblasts by inhibiting autophagy activation in tendon injury.Biosci Rep. 2022; 42 (BSR20210640.2021)
- Diabetes mellitus impairs tendon-bone healing after rotator cuff repair.J Shoulder Elbow Surg. 2010; 19: 978-988
- Diabetes mellitus increases the risk of rotator cuff tear repair surgery: A population-based cohort study.J Diabetes Complications. 2016; 30: 1473-1477
- Comparable clinical and structural outcomes after arthroscopic rotator cuff repair in diabetic and non-diabetic patients.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 3810-3817
- Rehabilitation after rotator cuff repair.Open Orthop J. 2017; 11: 154-162
- Growth factors for rotator cuff repair.Clin Sports Med. 2009; 28: 13-23
- Time to failure after rotator cuff repair: A prospective imaging study.J Bone Joint Surg Am. 2013; 95: 965-971
- When do rotator cuff repairs fail? Serial ultrasound examination after arthroscopic repair of large and massive rotator cuff tears.Am J Sports Med. 2011; 39: 2064-2070
- The association of perioperative glycemic control with adverse outcomes within 6 months after arthroscopic rotator cuff repair.Arthroscopy. 2019; 35: 1771-1778
- 2. Classification and diagnosis of diabetes.Diabetes Care. 2015; 38: S8-S16
- Effect of cigarette smoking on the clinical outcomes of ACL reconstruction.J Bone Joint Surg Am. 2014; 96: 1007-1013
- Relationship between bone mineral density and alcohol intake: A nationwide health survey analysis of postmenopausal women.PLoS One. 2017; 12e0180132
- Short-term effects of high-intensity laser therapy on frozen shoulder: A prospective randomized control study.Man Ther. 2015; 20: 751-757
- Quality of life after arthroscopic rotator cuff repair: Evaluation using SF-36 and an analysis of affecting clinical factors.Am J Sports Med. 2012; 40: 631-639
- Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle.Bone Joint J. 2013; 95-B: 935-941
- The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration.Clin Orthop Relat Res. 2005; 433: 90-96
- Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: A new classification based on arthroscopic observations.Arthroscopy. 2007; 23: 73-80
- Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging.J Shoulder Elbow Surg. 1999; 8: 599-605
- Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study.J Bone Joint Surg Am. 2007; 89: 953-960
- Results of a second attempt at surgical repair of a failed initial rotator-cuff repair.J Bone Joint Surg Am. 1984; 66: 563-567
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Single assessment numeric evaluation (SANE) is a reliable metric to measure clinically significant improvements following shoulder arthroplasty.J Shoulder Elbow Surg. 2019; 28: 2238-2246
- Thickness of the supraspinatus and biceps tendons in diabetic patients.Diabetes Care. 2002; 25: 408
- Insulin-dependent diabetes impairs the inflammatory response and delays angiogenesis following Achilles tendon injury.Am J Physiol Regul Integr Comp Physiol. 2004; 286: R952-R957
- The effect of diabetes, hyperlipidemia, and statins on the development of rotator cuff disease: a nationwide, 11-year, longitudinal, population-based follow-up study.Am J Sports Med. 2015; 43: 2126-2132
- Does diabetes mellitus predispose to both rotator cuff surgery and subsequent failure?.JSES Int. 2021; 5: 636-641
- Diabetes mellitus alters the mechanical properties of the native tendon in an experimental rat model.J Orthop Res. 2011; 29: 880-885
- Effect of isolated hyperglycemia on native mechanical and biologic shoulder joint properties in a rat model.J Orthop Res. 2014; 32: 1464-1470
- Altered gene and protein expressions in torn rotator cuff tendon tissues in diabetic patients.Arthroscopy. 2017; 33 (e511): 518-526
- Risk factors for retear after arthroscopic repair of full-thickness rotator cuff tears using the suture bridge technique: Classification system.Arthroscopy. 2016; 32: 2191-2200
Article info
Publication history
Published online: August 29, 2022
Accepted:
August 14,
2022
Received:
March 3,
2022
Footnotes
See commentary on page 183
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
