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

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

Tristan B Weir  1 , Mohit N Gilotra  1 , Michael J Foster  1 , Jessica Santos  2 , Joshua B Sykes  2 , Andrew F Kuntz  2 , G Russell Huffman  2 , David L Glaser  2
Affiliations

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

Tristan B Weir et al. J Clin Orthop Trauma. .

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.

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Conflict of interest statement

TBW, MJF, JS, and DLG have nothing to disclose. MNG and JBS report personal fees from Arthrex, Inc., outside the submitted work. JBS is a board or committee member of the American Academy of Orthopaedic Surgeons. AFK is a board or committee member of the American Board of Orthopaedic Surgery and the Orthopaedic Research Society, and reports grants from Integra Life Sciences, grants from Orthofix, Inc., outside the submitted work. GRH reports personal fees from Fx Shoulder, outside the submitted work.

Figures

Fig. 1
Fig. 1
Proton density fat saturated coronal image showing the landmarks to define the myotendinous junction (MTJ) position. A plum line was dropped from the medial aspect of the acromion (mAC) of the acromioclavicular joint, and a second plum line was dropped from the MTJ. The distance between the plum lines defined the position of the MTJ on the preoperative and postoperative MRIs. A positive value represents an MTJ position lateral to the mAC, while a negative value represents an MTJ position medial (i.e. more retracted) to the mAC. SSt, supraspinatus tendon; SSm, supraspinatus muscle belly.
See this image and copyright information in PMC

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