Preoperative tendon retraction, not smoking, is a risk factor for failure with continuity after rotator cuff repair

Tristan B Weir; Mohit N Gilotra; Michael J Foster; Jessica Santos; Joshua B Sykes; Andrew F Kuntz; G Russell Huffman; David L Glaser

doi:10.1016/j.jcot.2020.10.031

Preoperative tendon retraction, not smoking, is a risk factor for failure with continuity after rotator cuff repair

J Clin Orthop Trauma. 2020 Oct 20:15:76-82. doi: 10.1016/j.jcot.2020.10.031. eCollection 2021 Apr.

Authors

Tristan B Weir¹, Mohit N Gilotra¹, Michael J Foster¹, Jessica Santos², Joshua B Sykes², Andrew F Kuntz², G Russell Huffman², David L Glaser²

Affiliations

¹ Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
² Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

Background: Smoking is a poor prognostic factor for healing after rotator cuff repair and is associated with inferior results. We hypothesized that smokers would have higher recurrent tear rates and more postoperative myotendinous junction (MTJ) retraction in healed repairs than nonsmokers three months postoperatively.

Methods: Rotator cuff repairs (RCRs) were retrospectively reviewed over a 2-year period. Patients underwent magnetic resonance imaging (MRI) within 6 months prior to surgery and again at 3 months postoperatively. Seventy-nine patients were included and stratified by smokers versus nonsmokers. Baseline patient demographics, tear characteristics, and surgical factors were collected. Preoperative and postoperative MRIs were assessed to quantify the MTJ position and to establish the recurrent tear rate.

Results: For the total cohort (nonsmokers, n = 56; smokers, n = 23), significant differences in age, race, and traumatic onset of injury existed between groups. There were no significant differences in recurrent tear between smokers (26%) and nonsmokers (27%), but nonsmokers were more satisfied. For patients with healed RCRs (nonsmokers, n = 41; smokers, n = 17), there were significant differences in race. On univariate analysis, nonsmokers had a significantly more lateral MTJ postoperatively (P = 0.05). On multivariable regression analysis, medialized postoperative MTJ position in healed cuffs was driven only by greater preoperative rotator cuff retraction preoperatively. There were no significant differences in MTJ position based on smoking status for patients with healed RCRs.

Conclusion: Smoking does not appear to be an independent risk factor for postoperative MTJ retraction in healed RCRs, also known as failure in continuity. Preoperative tear size and retraction play the biggest roles in predicting postoperative MTJ position, regardless of smoking status. There are no significant differences in patient-reported outcomes for patients with healed RCRs, but nonsmokers had more satisfaction following RCR in the total cohort.

Level of evidence: Level III; Retrospective cohort study; Diagnostic study.

Keywords: ASES, American Shoulder and Elbow Surgeons Score; CI, confidence interval; FS, fat suppression; Failure with continuity; ICC, intraclass correlation coefficient; MRI, magnetic resonance imaging; MTJ, myotendinous junction; Myotendinous junction; NRS, numeric rating scale; PD, proton density; Penn, Penn Shoulder Score; RCR, rotator cuff repair; Rotator cuff; Smoking; mAC, medial aspect of the acromion.