FACTORS PREDICTIVE OF CUFF TENDON HEALING AFTER ARTHROSCOPIC REPAIR

Abstract

Purpose of the study: The objective of this study was to identify clinical and anatomic factors which could affect the outcome of tendon healing after arthroscopic repair of rotator cuff tears.

Material and methods: This prospective cohort study included 122 patients who underwent arthroscopic treatment between May 1999 and September 2002. One hundred twelve patients (114 shoulders) were reviewed (93.4%). Mean age at surgery was 61 years. An arthroscan (78% of patients) or magnetic resonance imaging (MRI) were performed six months postoperatively. Mean follow-up was 24 months (range 13–46 months).

Results: Rotator cuff tears healed completely in 64% of the shoulders (n=73) and partially in 7% (n=8). No healing was observed in 29% (n=33). The Constant score was 49.8 preoperatively and 82.4 at last follow-up (p< 0.0001). Cuff healing improved clinical outcome with a Constant score of 85 points versus 77, particularly for force, 14.5 points versus 10 without healing. Four factors were statistically predictive of tendon healing: duration from symptom onset to operation (24 months for healed tears versus 37 months, p< 0.05); age at cuff repair (81% healed tears in patients aged less than 50 years versus 50% for patients aged over 65 years, p< 0.002); sagittal extension of the rotator interval or extension to the upper third of the infrascapularis (45% healed tears versus 79% without anterior extension, p< 0.0001); fatty degeneration (69% of healed tears for Goutallier grade 0 versus 38% for grade 1 and 2, p< 0.01).

Conclusion: This study demonstrated that four factors can predict tendon healing: time to treatment, age at surgery, anterior extension of the tear, fatty degeneration.