Risk factors for retear of large/massive rotator cuff tears after arthroscopic surgery: an analysis of tearing patterns

Background: Previous studies have evaluated the risk factors for retear of large/massive rotator cuff tears (RCTs) that were treated arthroscopically; however, most studies did not evaluate tear patterns. The present study hypothesized that postoperative risk factors are affected by the tearing patterns in large/massive cuff tears in patients undergoing arthroscopic rotator cuff repair (ARCR). Methods: One hundred fifty patients with large/massive cuff tears underwent ARCR at our institution. Of these, 102 patients were enrolled in this study, with an average symptom duration of 36.3 +/- 43.9 months and average age of 63. 9 +/- 9.4 years. According to the arthroscopic findings and magnetic resonance imaging (MRI), the 102 patients were divided into three groups based on the tendon location: anterosuperior tears (N = 59, group AS), posteosuperior tears (N = 21, group PS), and anteroposterior-extending tears (N = 22, group APE). Functional outcome was evaluated preoperatively and postoperatively using the Japanese Orthopedic Association (JOA) score and the University of California, Los Angeles (UCLA) score. Retear was evaluated with MRI at a minimum of 1 year after surgery, using Sugaya's classification; Types IV and V were considered postoperative retears. Factors affecting postoperative retear were examined with univariate and multivariate analyses. Results: JOA/UCLA scores significantly improved postoperatively in the three groups (P < 0.01 for all). Postoperative retear was noted in 26 of 102 patients (25.5%) in this series: 10 patients in group AS (16.9%), 9 in group PS (42.9%), and 7 in group APE (31.8%). The retear rate was significantly higher in group PS than in the other two groups (P = 0.02). Multivariate analysis showed that decreased preoperative active external rotation range was a unique risk factor for postoperative retear in the PS and APE groups (95% confidence interval: 0.02-0.18, cut-off value: 25 degrees, with an area under the curve of 0.90, P = 0.0025). Conclusions: Although multivariate analysis failed to detect significant risk factor for retear in patients with anterosuperior large/massive cuff tears who undergo ARCR, it demonstrated that active external rotation less than 25 degrees before surgery is a significant risk factor in those with posterosuperior large/massive tears. This study may help surgeons understand the results of arthroscopic surgery in patients with large/massive tears.