The association between tendon quality and clinical outcomes in rotator cuff repair

Rotator cuff tendon injuries often necessitate surgical intervention to restore function and alleviate pain. The integrity of the tendon-specifically its quality, the extent of tendon loss, and the presence of delamination-may influence postoperative outcomes. The purpose of this study was to evaluate the association between these tendon characteristics and patient-reported outcomes (PROs) after rotator cuff tendon repair.

A retrospective chart review was performed for patients who underwent rotator cuff repair by a single surgeon at an academic institution between 2016 and 2022. This author recorded tendon quality, tendon loss, and tendon delamination on every single case immediately after it was performed. Tendon quality was graded as poor when sutures pulled through the tendon. Tendon loss was graded based upon tendon length remaining. PRO collected preoperatively and at a minimum of two-years postoperatively included the American Shoulder and Elbow Surgeons (ASES) score and the Subjective Shoulder Value (SSV) score.

Of 424 patients (441 shoulders) who met inclusion criteria, 2-year outcomes were available for 77% (339/441). The cohort was 57 ± 10 years, had 39% female, with an average body mass index of 30 ± 5.7. Supraspinatus/infraspinatus tears were full thickness in 59% (202/339) and partial thickness in 34% (117/339), with 7% (23/339) having isolated subscapularis tears. PROs changed from ASES 51 ± 19, SSV 45 ± 20, and visual analog scale 4.7 ± 2.3 preoperatively to ASES 89 ± 15, SSV 89 ± 15, and visual analog scale 0.85 ± 1.6 postoperatively. Tendon quality was good in 83% (282/339), fair in 13% (44/339), and poor in 4% (13/339). Tendon loss was minimal in 86% (291/339) and substantial in 14% (48/339). Delamination was present in 16% (55/339). Multivariable analysis showed that poor tendon quality and substantial tendon loss (<16 mm tendon length remaining) were independently associated with worse postoperative ASES scores (P = .019 and .005, respectively).

Substantial tendon loss and poor tendon quality should be considered as poor prognostic indicators in rotator cuff repair outcomes. In those patients with poor tendon quality or substantial tendon loss, surgeons could consider augmentation.