Sheean AJ, et al. - This study was performed to investigate the associations of preoperative imaging findings of massive rotator cuff (RC) tears with incomplete arthroscopic repair, the use of advanced mobilization techniques (interval slides) and/or the use of a load-sharing rip stop repair construct. The identified risk factors for incomplete RC repair included a positive tangent sign and/or high-grade fatty infiltration (Goutallier 3-4) of the supraspinatus. However, data showed that as the majority of massive RC tears with these imaging characteristics were still fully reparable, these factors were not completely predictive of reparability.

Methods

• Researchers performed a retrospective assessment in 86 consecutive patients who underwent arthroscopic repair for massive RC tears performed by a single surgeon between July 2013 and July 2015.
• They analyzed previously proposed radiographic risk factors for irreparability (acromiohumeral distances, tangent sign, and the Goutallier stage of fatty infiltration for the supraspinatus).
• They used binary logistic regressions and Fisher's exact tests to determine the links between preoperative imaging characteristics and intraoperative results of RC surgery.
• Using intraclass correlation coefficients (ICCs), they determined the interobserver reliability of imaging characteristics.

Results

• Data reported that 76 massive RC tears were fully reparable (88%) and, in the case of 10 RC tears (12%), a complete repair was not obtained.
• Researchers reported an association of inability to obtain a complete repair of the supraspinatus with a positive tangent sign (30% irreparable) vs a negative tangent sign (6.3% irreparable, odds ratio [OR] = 6.3, P=.0102) and with Goutallier grade 3-4 fatty infiltration of the supraspinatus (42.9% irreparable) vs grade 0-2 fatty infiltration (5.7% irreparable, OR = 11.8, P=.001).
• Findings also revealed that in 62% of cases, advanced arthroscopic techniques (interval slides or load-sharing rip stop) for dealing with poor-quality or retracted tendon were used; however, preoperative imaging characteristics were not associated with these techniques.
• In addition, moderate interobserver reliability was noted (ICC = 0.75-0.90) for the tangent sign (ICC = 0.78) and high-grade (Goutallier 3-4) fatty infiltration of the supraspinatus (ICC = 0.74).