title: Morphologic Risk Factors in Predicting Symptomatic Structural Failure of Arthroscopic Rotator Cuff Repairs: Tear Size, Location, and Atrophy Matter.
abstract: To evaluate whether morphologic characteristics of rotator cuff tear have prognostic value in determining symptomatic structural failure of arthroscopic rotator cuff repair independent of age or gender.
  
  
  
  Arthroscopic rotator cuff repair cases performed by five fellowship-trained surgeons at our institution from 2006 to 2013 were retrospectively reviewed. Data extraction included demographics, comorbidities, repair technique, clinical examination, and radiographic findings. Failure in symptomatic patients was defined as structural defect on postoperative magnetic resonance imaging or pseudoparalysis on examination. Failures were age and gender matched with successful repairs in a 1:2 ratio.
  
  
  
  A total of 30 failures and 60 controls were identified. Supraspinatus atrophy (P = .03) and tear size (18.3 mm failures v 13.9 mm controls; P = .02) were significant risk factors for failure, as was the presence of an infraspinatus tear greater than 10 mm (62% v 17%, P < .01). Single-row repair (P = .06) and simple suture configuration (P = .17) were more common but similar between groups. Diabetes mellitus and active tobacco use were not significantly associated with increased failure risk but psychiatric medication use was more frequent in the failure group.
  
  
  
  This study confirms previous suspicions that tear size and fatty infiltration are associated with failure of arthroscopic rotator cuff repair but independent of age or gender in symptomatic patients. There is also a quantitative cutoff on magnetic resonance imaging for the size of infraspinatus involvement that can be used clinically as a predicting factor. Although reported in the literature, smoking and diabetes were not associated with failure.
  
  
  
  Level III, retrospective case control.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Gregory
authors.initials: G
authors.lastname: Gasbarro
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Jason
authors.initials: J
authors.lastname: Ye
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Hillary
authors.initials: H
authors.lastname: Newsome
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Kevin
authors.initials: K
authors.lastname: Jiang
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Vonda
authors.initials: V
authors.lastname: Wright
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Dharmesh
authors.initials: D
authors.lastname: Vyas
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: James J
authors.initials: JJ
authors.lastname: Irrgang
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.. Electronic address: musahlv@upmc.edu.
authors.forename: Volker
authors.initials: V
authors.lastname: Musahl
mesh_terms: D001182:Arthroscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery*; D000070636:Rotator Cuff Injuries / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology