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Older age and higher body mass index are independent risk factors for tendon healing in small- to medium-sized rotator cuff tears

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Many previous research efforts have been made to identify prognostic factors for rotator cuff healing. However, majority of these studies were conducted with heterogeneous cohorts consisted of different tear characteristics. Healing properties of a rotator cuff tear may differ depending on tear characteristics such as tear size or fatty infiltration. Therefore, studies with subgroups confined by these variables may reflect more accurate results. This study aims to investigate predictive factors for rotator cuff healing in a subgroup with small- to medium-sized tears without significant fatty infiltration.

Methods

This retrospective case–control study was conducted with 94 patients with small- to medium-sized rotator cuff tears. Mean age of patients was 56.0 ± 9.0 years and mean follow-up duration was 38.3 ± 8.1 months. Post-operative magnetic resonance imaging assessment showed that there were 75 (79.8%) successfully healed repairs and 19 (20.2%) healing failures. Age, gender, hand dominancy, body mass index (BMI), smoking habit, diabetes, corticosteroid injection, baseline clinical status, duration of surgery and biceps procedure were variables evaluated as predictive factors.

Results

Both study groups showed significant improvement from baseline regarding clinical outcome measures (p < 0.05). However, successfully healed patients had significantly higher post-operative functional scores and lower pain scores (p < 0.05). The univariate analysis revealed that healing was significantly affected by age (p = 0.004), BMI (p = 0.01) and diabetes (p = 0.03). In the multivariate analysis, age (p = 0.02) and BMI (p = 0.02) were found to be significant independent factors for healing. Cutoff values for oldest age and highest BMI were 63 years and 28.1 kg/m2, respectively, for a successful healing according to receiver-operating characteristic curve analysis.

Conclusion

Healing failure after rotator cuff repair in small- to medium-sized tears is associated with poorer outcomes. Age and BMI are independent predictive factors for healing. A successful repair is more likely in patients younger than 63 years and with BMI less than 28.1 kg/m2. Surgeons should consider this information during risk assessment, decision making and patient counselling.

Level of evidence

Level III.

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No funding was received for this study.

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Authors and Affiliations

  1. Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, Istanbul, Turkey

    Ali Erşen & Muhammed Oğuzhan Albayrak

  2. Faculty of Medicine, Department of Orthopedics and Traumatology, Bezmialem Vakif University, Topkapi Adnan Menderes Bulvari, 34093, Fatih, Istanbul, Turkey

    Koray Şahin

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  1. Ali Erşen
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Correspondence to Koray Şahin.

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Erşen, A., Şahin, K. & Albayrak, M.O. Older age and higher body mass index are independent risk factors for tendon healing in small- to medium-sized rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 31, 681–690 (2023). https://doi.org/10.1007/s00167-022-07234-6

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