Factors influencing rotator cuff tendon healing after arthroscopic repair

Authors: N. Brassart, C. Trojani, M. Carles, P. Boileau

References: SECEC 2005

Abstract
AIMS: The purpose of this study is to identify the clinical and anatomic criteria influencing rotator cuff tendon healing after arthroscopic cuff repair.

MATERIALS: Follow-up study of a cohort of 122 patients arthroscopically repaired using tension band technique between May 1999 and September 2002. We were able to review 112 patients (114 shoulders, 93%). The average age at surgery was 61 years. Healing was systematically evaluated at 6 months post-operatively by CT arthrography (78%) or MRI. Average follow-up was 24 months (13-46 months).

RESULTS: The rotator cuff was healed in 64% of cases (n=73) and partially healed in 7% (n=8). An absence of healing was observed in 29% of cases (n=33). Constant score improved from 49.8 points preop to 82.4 at last review (p<0.00001). A healed tendon improved clinical results Constant score of 85 points versus 77 points in the absence of healing with strength achieved 14.5 points versus 10 points. Four predictive factors statistically influenced tendon healing:

  • Time interval between symptom onset and surgery (24 months for healed cuffs versus 37 months; p<0.05)
  • patient’s age at cuff repair (81% of cuffs healed in patients under the age of 50, opposed to 50% in those over 65 years; p<0.0002))
  • sagittal extension of the cuff tear to the rotator interval or superior 1/3 of the Subscapularis (only 45% of cuffs healed versus 79% in the absence of anterior tear extension; p<0.00001))
  • extent of fatty infiltration of the rotator cuff muscles (69% of cuffs healed with Goutallier stage 0 and 38% with stages 1 and 2; p<0.01).

    CONCLUSION: This study reveals 4 predictive factors that influence cuff healing: the interval between symptom onset and surgery, age at surgery, the anterior extension of the lesion, and fatty infiltration of the musculature.

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