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How Much Will High Tension Adversely Affect Rotator Cuff Repair Integrity?
Arthroscopy 2019; 35(11):2992-3000A

Abstract

PURPOSE

To suggest a cutoff value of tension related to retear of a repaired chronically contracted rotator cuff and to analyze the correlation between predictive factors and integrity of repair in large to massive contracted rotator cuff tears (RCTs).

METHODS

We analyzed arthroscopic rotator cuff repairs for large to massive (>3 cm) contracted RCTs, not amenable to complete repair by standard means with meticulous release, with a minimum of 1 year follow-up. An intraoperative procedure was designed for the estimation of repair tension using a tensiometer. Clinical and radiological findings were compared between the healed group and the retear group, and magnetic resonance imaging was performed ∼1 year postoperatively for the evaluation of integrity of the repair site. The receiver operating characteristic curve was used to identify the cutoff value of the independent factors. Factors affecting postoperative retear were examined with multivariate analysis.

RESULTS

Fifty patients were enrolled in this study and divided into the healed group (31 patients) and the retear group (19 patients) according to the follow-up magnetic resonance imaging findings. Significant results showed that tension (5.13 < 95% confidence interval [CI] < 58.15, P < .001) and acromiohumeral interval (AHI) (1.13 < 95% CI < 33.10, P = .013) were important factors for the integrity of rotator cuff repair. The cutoff value of tension was 35 N, and an AHI <6.6 mm may also be considered a predictor of retear. An occupation ratio of the tension >35 N was the strongest predictor of retear, with an area under the curve of 0.799, sensitivity of 84.2%, and specificity of 67.7% (accuracy = 76.0%).

CONCLUSIONS

The integrity of a large to massive rotator cuff repair is strongly related to the tension to reach the articular margin of the footprint and AHI. We found that the possibility of retear increases when tension ≥35 N is required. AHI <6.6 mm may also be considered a predictor of retear.

LEVEL OF EVIDENCE

Level III, retrospective cohort design.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.Department of Orthopaedic Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea. Electronic address: redpross@naver.com.Department of Orthopaedic Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31629587

Citation

Park, Sam-Guk, et al. "How Much Will High Tension Adversely Affect Rotator Cuff Repair Integrity?" Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 35, no. 11, 2019, pp. 2992-3000.
Park SG, Shim BJ, Seok HG. How Much Will High Tension Adversely Affect Rotator Cuff Repair Integrity? Arthroscopy. 2019;35(11):2992-3000.
Park, S. G., Shim, B. J., & Seok, H. G. (2019). How Much Will High Tension Adversely Affect Rotator Cuff Repair Integrity? Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 35(11), pp. 2992-3000. doi:10.1016/j.arthro.2019.05.049.
Park SG, Shim BJ, Seok HG. How Much Will High Tension Adversely Affect Rotator Cuff Repair Integrity. Arthroscopy. 2019;35(11):2992-3000. PubMed PMID: 31629587.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How Much Will High Tension Adversely Affect Rotator Cuff Repair Integrity? AU - Park,Sam-Guk, AU - Shim,Bum-Jin, AU - Seok,Hyun-Gyu, Y1 - 2019/10/16/ PY - 2019/01/18/received PY - 2019/05/21/revised PY - 2019/05/23/accepted PY - 2019/10/21/pubmed PY - 2019/10/21/medline PY - 2019/10/21/entrez SP - 2992 EP - 3000 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 35 IS - 11 N2 - PURPOSE: To suggest a cutoff value of tension related to retear of a repaired chronically contracted rotator cuff and to analyze the correlation between predictive factors and integrity of repair in large to massive contracted rotator cuff tears (RCTs). METHODS: We analyzed arthroscopic rotator cuff repairs for large to massive (>3 cm) contracted RCTs, not amenable to complete repair by standard means with meticulous release, with a minimum of 1 year follow-up. An intraoperative procedure was designed for the estimation of repair tension using a tensiometer. Clinical and radiological findings were compared between the healed group and the retear group, and magnetic resonance imaging was performed ∼1 year postoperatively for the evaluation of integrity of the repair site. The receiver operating characteristic curve was used to identify the cutoff value of the independent factors. Factors affecting postoperative retear were examined with multivariate analysis. RESULTS: Fifty patients were enrolled in this study and divided into the healed group (31 patients) and the retear group (19 patients) according to the follow-up magnetic resonance imaging findings. Significant results showed that tension (5.13 < 95% confidence interval [CI] < 58.15, P < .001) and acromiohumeral interval (AHI) (1.13 < 95% CI < 33.10, P = .013) were important factors for the integrity of rotator cuff repair. The cutoff value of tension was 35 N, and an AHI <6.6 mm may also be considered a predictor of retear. An occupation ratio of the tension >35 N was the strongest predictor of retear, with an area under the curve of 0.799, sensitivity of 84.2%, and specificity of 67.7% (accuracy = 76.0%). CONCLUSIONS: The integrity of a large to massive rotator cuff repair is strongly related to the tension to reach the articular margin of the footprint and AHI. We found that the possibility of retear increases when tension ≥35 N is required. AHI <6.6 mm may also be considered a predictor of retear. LEVEL OF EVIDENCE: Level III, retrospective cohort design. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/31629587/How_Much_Will_High_Tension_Adversely_Affect_Rotator_Cuff_Repair_Integrity L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(19)30497-9 DB - PRIME DP - Unbound Medicine ER -