Critical Predictors of the Outcomes of Rotator Cuff Arthroscopic Repair

Abstract

Objective To evaluate the functional outcomes after rotator cuff arthroscopic repair in an adult population and to establish risk factors for poor prognosis in this procedure.

Methods This retrospective cohort study analyzed medical records of 302 shoulders that underwent arthroscopy for rotator cuff repair between October 1, 2014, and December 31, 2017. Patients were included if they had a complete rotator cuff injury and met other specific criteria. Surgical procedures were performed consistently, and postoperative care involved a structured rehabilitation protocol. The primary outcome measure was the need for further surgery or a University of California, Los Angeles (UCLA) shoulder score < 28 at 2 years postsurgery. Statistical analyses included descriptive, inferential, and logistic regression methods.

Results Treatment success was observed in 234 shoulders (77.5%), while 68 shoulders (22.5%) were classified as treatment failures. Factors significantly associated with treatment failure included having more than 2 affected tendons (OR: 2.8, 95%CI: 1.5–5.0) and lesion sizes greater than 25 mm (OR: 2.9; 95%CI: 1.6–5.3). Patients aged 75 years or older had a failure rate of 54.5%, compared to 21.3% in younger patients (p = 0.019). The Goutallier classification for fatty degeneration was significantly worse in older patients (p = 0.001). Critical patients, defined as those aged ≥ 75 years with a Goutallier classification > 2 and lesion sizes > 25 mm, had a treatment failure rate of 75.0% (OR: 11.2; 95%CI: 2.2–57.0).

Conclusion Rotator cuff arthroscopy showed no worse prognosis based solely on age until 75 years. However, patients older than 75 years with significant muscle degeneration and large lesions had substantially increased chances of poor outcomes. Alternative treatments should be considered for these critical patients to improve their quality of life and upper limb functionality.

Keywords

arthroscopy - elderly - retrospective studies - rotator cuff injuries - shoulder pain

Authors' Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MCP, CLSF, PCM and RACC The first draft of the manuscript was written by MCP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Work carried out at the Division of Orthopedics, Rede Sarah Hospitais de Reabilitação, Brasília, DF, Brazil.

Publication History

Received: 11 April 2024

Accepted: 09 January 2025

Article published online:
28 April 2025

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