Published online Dec 18, 2022. doi: 10.5312/wjo.v13.i12.1038
Peer-review started: July 25, 2022
First decision: October 17, 2022
Revised: October 22, 2022
Accepted: November 30, 2022
Article in press: November 30, 2022
Published online: December 18, 2022
The reparability of large or massive rotator cuff tears is difficult to determine pre-operatively. We previously identified age ≥ 65 years, acromiohumeral interval ≤ 6 mm, and anteroposterior tear size ≥ 22 mm as risk factors for rotator cuff repair failure. We therefore developed a rotator cuff reparability score where each of the above risk factors is assigned a score of one point.
To determine the accuracy of a rotator cuff reparability score.
This was a retrospective cohort study of recruited patients with large or massive rotator cuff tears treated at our institution between January 2013 and December 2019. Exclusion criteria were revision surgery and patients with contraindications for surgery. All patients underwent arthroscopic rotator cuff repair and were categorized into either complete or partial rotator cuff repair. Rotator cuff reparability scores were calculated for each patient. The sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio were assessed. A receiver operating characteristic curve was plotted to determine the optimal cut-off rotator cuff reparability score.
Eighty patients (mean age, 61 years; range, 25–84 years; 41 females and 39 males) were recruited. Intra- and inter-observer reliabilities were good to excellent. The number of patients with 0, 1, 2, and 3 risk factors for rotator cuff repair failure were 24, 33, 17, and 6, respectively. Complete repair was performed in all patients without risk factors. Two of the 33 patients with one risk factor and seven of the 17 patients with two risk factors underwent partial repair. One of the six patients with three risk factors underwent complete repair. The area under the curve was 0.894. The optimal cut-off score was two points with a sensitivity of 85.71% and a specificity of 83.33%.
A rotator cuff reparability score of two was determined to be the optimal cut-off score for predicting the reparability of large or massive rotator cuff tears.
Core Tip: This is retrospective study to evaluate the accuracy of a novel rotator cuff reparability score. In large or massive rotator cuff tears, arthroscopic rotator cuff repair is not always feasible. The reparability of large or massive rotator cuff tears can be more accurately determined after intra-operative arthroscopy. The identification of pre-operative risk factors for rotator cuff tear repair failure may facilitate improvements in management and provide patients with more accurate treatment information. Accordingly, we developed a novel scoring system to predict the likelihood of rotator cuff repair failure.