ARE THERE ANY DIFFERENCES IN CLINICAL OUTCOMES BETWEEN PATIENTS WITH A RETEAR OF SUPRASPINATUS TENDON REPAIR AND THOSE WITH AN INTACT REPAIR AT THE 5-YEAR FOLLOW-UP?

Abstract

<p><strong>Background</strong></p><p>It is well-known that rotator cuff repair is associated with an overall retear rate of 21% to 26%. However, a cuff retear may not necessarily be associated with poor clinical outcomes.</p><p><br></p><p><strong>Hypothesis</strong></p><p>The hypothesis was that there would be no difference in clinical outcomes between patients with a cuff retear and those with an intact repair at a mid-term follow-up of five years.</p><p><br></p><p><strong>Study Design</strong></p><p>Retrospective cohort study, Level IV</p><p><br></p><p><strong>Methods</strong></p><p>A retrospective study was conducted involving patients who received arthroscopic complete repair of the supraspinatus tendon between January 2009 and December 2017. Patients who did not have a post-operative MRI or a follow-up of less than 5 years were excluded. Clinical outcomes, including the visual analogue scale (VAS), American Shoulder and Elbow Surgeon Score (ASES), and active forward flexion of the involved shoulder (FF) were assessed at the two-year and five-year follow-up. </p><p><br></p><p><strong>Results</strong></p><p>One hundred and five patients were enrolled. The average follow-up period was 85 months. MRI scans were performed at a mean of 20 months. Fourteen full-thickness cuff retears and 91 intact repairs were identified using post-operative MRI. Significant improvement in VAS, ASES and FF were found between pre-operation and the two designated time-points of follow-up (2-year and 5-year, respectively) in both the cuff retear and intact repair groups (p<0.001). The VAS and ASES scores at the 2-year follow-up for the intact repair group were 1.8 +/- 2.0 and 80.7 +/- 18.1, respectively. The corresponding figures for the retear group were 2.3 +/- 2.2 and 71.9 +/- 19.5, respectively. There was no difference between the two groups in the VAS and ASES at the 2-year follow-up. However, patients with an intact repair had a better VAS (1.4 +/- 1.8, p=0.049) and ASES (81.7 +/- 17, p=0.019) than those with a cuff retear at the 5-year assessment (3 +/- 2.8 and 67.1 +/- 22.9, respectively). Ninety-one percentage of patients in the intact repair group achieved the minimal clinically important difference (MCID) in the 5-year VAS, compared to 54% in cuff retear group (p<0.001). The corresponding figures for the 5-year ASES were 80% and 54%, respectively (p=0.044).</p><p>FF at the 5-year follow-up in patients with intact repair and those with a cuff retear were 161 +/- 23 degrees and 144 +/- 37 degrees, respectively (p=0.059). Continuous improvement in VAS and FF between the 2-year and 5-year follow-up was observed in the intact repair group (p=0.005 and p=0.04, respectively). </p><p><br></p><p><strong>Conclusion</strong></p><p>The patients with an intact repair had better VAS and ASES scores compared to those with a cuff retear at a mid-term follow-up of five years. There was continuous improvement in VAS and FF in the intact repair group between the 2-year and the 5-year follow-up.</p><p><br></p><p><strong>Keywords</strong></p><p>Rotator cuff tear; clinical outcomes; cuff retear; MRI; 5-year follow-up</p><p><br></p><p><strong>What is known about the subjects?</strong></p><p>It is known that the rate of full-thickness retear after rotator cuff repair is around 21%. Patient-reported outcomes generally improve irrespective of the integrity of the repaired tendon. Only a small percentage of patients with a full-thickness retear of the repaired tendon require revision surgery. Short term clinical outcomes are comparable between the cuff retear and the intact repair groups. However, there is controversy over whether a significant difference in clinical outcomes exists between the two groups at a mid-term to long-term follow-up. </p><p><br></p><p><strong>What this study adds to existing knowledge?</strong></p><p>The current study showed that a difference in clinical outcomes existed between the intact repair group and the cuff retear group at a mid-term follow-up of five years. Although the VAS and ASES scores between the two groups were comparable at the 2-year assessment, patients in the intact repair group performed better than those in the cuff retear group at the 5-year follow-up. Continuous improvement in VAS and FF were noted in the intact repair group between the 2-year and 5-year follow-up. A similar change was not found in the cuff retear group. </p>