title: Factors Affecting Clinical Outcome in Patients With Structural Failure After Arthroscopic Rotator Cuff Repair.
abstract: (1) To compare clinical outcomes between patients with large or massive rotator cuff tears who have healed cuffs and patients with postoperative structural failure (retear after complete or partial repair) and (2) to identify factors associated with clinical outcomes in patients with postoperative structural failure.
  
  
  
  We conducted a retrospective study of consecutive patients with large or massive cuff tears who underwent arthroscopic repair at our institution between 2005 and 2012. On the basis of intraoperative findings and magnetic resonance imaging at final follow-up, the patients were divided into 3 groups: healed group, retear group (after complete repair), and partial-repair group. The outcome measures comprised the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA) scores; muscle strength; and range of motion. The tear length, tear width, muscle atrophy, and fatty degeneration were evaluated by preoperative and postoperative magnetic resonance imaging. The extent of tendon reattachment to the superior, middle, and inferior facets and the lesser tuberosity was examined on magnetic resonance images at final follow-up.
  
  
  
  In total, 74 patients (healed, 41; retear, 19; and partial repair, 14) were included in this study. The mean age was 63.8 ± 8.5 years, with a mean follow-up period of 3.6 ± 1.4 years. The postoperative JOA and UCLA scores significantly improved in all 3 groups, but the differences were not significant. In the retear and partial-repair groups, postoperative tendon preservation at the middle facet significantly affected the JOA and UCLA scores (P = .003 and P = .014, respectively).
  
  
  
  The JOA and UCLA scores were significantly improved in patients with structural failure. Under these conditions, the only clinical factor that affected patient outcome was tendon healing at the middle facet. Thus tendon preservation at the middle facet was a predictor of good clinical outcomes in patients who underwent arthroscopic rotator cuff repair of large or massive tears and had postoperative structural failure.
  
  
  
  Level III, case-control study.
authors: Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan.
authors: Hidehiro
authors: H
authors: Nakamura
authors: Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan. Electronic address: gomasa@med.kurume-u.ac.jp.
authors: Masafumi
authors: M
authors: Gotoh
authors: Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan.
authors: Yasuhiro
authors: Y
authors: Mitsui
authors: Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan.
authors: Hirokazu
authors: H
authors: Honda
authors: Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan.
authors: Hiroki
authors: H
authors: Ohzono
authors: Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan.
authors: Hisao
authors: H
authors: Shimokobe
authors: Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan.
authors: Isao
authors: I
authors: Shirachi
authors: Division of Microscopic and Developmental Anatomy, Department of Anatomy, School of Medicine, Kurume University, Fukuoka, Japan.
authors: Tomonoshin
authors: T
authors: Kanazawa
authors: Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan.
authors: Takahiro
authors: T
authors: Okawa
authors: Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan.
authors: Fujio
authors: F
authors: Higuchi
authors: Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan.
authors: Naoto
authors: N
authors: Shiba
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D063868:Patient Outcome Assessment; D016059:Range of Motion, Articular; D012008:Recurrence; D012189:Retrospective Studies; D012399:Rotation; D000070636:Rotator Cuff Injuries / Q000000981:diagnostic imaging / Q000601:surgery*