Title : Are all large rotator cuff tears created equal? Prognostic factors in surgically repaired large rotator cuff tears from the New Zealand rotator cuff cohort
Abstract:
Background: Large and retracted rotator cuff tears pose a difficult challenge for orthopaedic surgeons, with poorer outcomes noted in surgically repaired tendons. The New Zealand Rotator Cuff cohort represents the largest prospective cohort of rotator cuff repairs. In our cohort, there was a significant difference in outcomes in those with tears greater than 4cm. The aim of the current study was to analyse the pain, functional and re-operation outcomes of large (>4cm) rotator cuff tears that had undergone surgical repair. Secondarily, look for positive and negative prognostic factors for surgical outcomes in those with tears >4cm.
Study Design: Prospective cohort study
Methods: This study was a multi-centre, multi-surgeon prospective cohort study of rotator cuff repairs from March 2009 until December 2010. Surgical data was collected by the operating surgeon. Flex SF (functional score), pain, post-operative data was collected at baseline, 6-, 12-, 24-months, 5 years, and now 14 years. We isolated large (>3cm) and massive (>5cm) tears from this cohort to analyse positive and negative prognostic factors.
Results: Overall, 264 tears larger than 4cm in anterior-posterior distance were analysed (this represents 10% of our overall cohort). Five year data is available for 81% of the cohort, 14 year data is now under collection (and will be available by the middle of the year). Tears over 4cm had lower 5 year Flex SF scores compared to smaller tears. The average Flex SF improvement score in tears over 4cm was of 13.5 (note: the minimal clinically important difference for Flex SF is 3 points). “Good” tendon quality had higher Flex SF scores vs “Poor” tendon quality. If tendon was ‘easily’ reducible, there was no difference in Flex SF score compared to smaller tears. 4% of large tears at 10 years had undergone a reverse shoulder replacement. Re-operation rate was 7.6%. A retrospective analysis of pre-operative MRI scans was carried out, fatty infiltration, glenohumeral arthrosis, and AC joint spurring had negative prognostic features.
Conclusion: Tears over 4cm had lower 5 year Flex SF scores, however the improvement from pre operative still was significantly higher that the minimally clinically important difference. Good prognostic factors included good tendon quality, easily reducible tendon stump, and lack of fatty infiltration and glenohumeral arthritis.
