Risk factors for retear of arthroscopic rotator cuff repair using triple-row technique

The triple-row (TR) technique enhances tendon-to-bone contact and repair integrity in arthroscopic rotator cuff repair (ARCR). However, limited studies have evaluated the clinical outcomes and risk factors for retears following this technique. This study aimed to compare clinical outcomes between retear and nonretear groups after ARCR using the TR technique and identify risk factors for retear.

Patients who underwent ARCR using the TR technique with at least 24 months follow-up were enrolled and categorized into retear and nonretear groups. Clinical outcomes, including range of motion, visual analog scale for pain, Constant Shoulder (CS), and University of California Los Angeles (UCLA) score, were evaluated at 3, 6, and 24 months postoperatively. The retear rate and tendon integrity were assessed at 3, 6, and 24 months follow-up using magnetic resonance imaging, and risk factors for retear were analyzed.

Of 181 patients enrolled, 20 (11%) had retears and 161 (89%) had no retears. The retear group was significantly older (P = .037) and had more large or massive tears (P = .044), larger tear sizes on magnetic resonance imaging (coronal plane: 29.9 ± 14.9 mm vs. 21.6 ± 12 mm, P = .005; sagittal plane: 23.7 ± 12.1 mm vs. 17.9 ± 9.4 mm, P = .013), and greater fatty infiltration (P < .001). Both groups achieved good clinical outcomes, but the retear group showed significantly lower CS and UCLA scores at 6 and 24 months (CS score: 72.4 ± 9 point vs. 78.6 ± 8.6 point at 6 months [P = .004] and 81.2 ± 11.1 point vs. 86.3 ± 9.6 point at 24 months [P = .032]; UCLA score: 25 ± 2.6 point vs. 27.3 ± 3.5 point at 6 months [P = .005], 28.7 ± 4.6 point vs. 30.9 ± 3.7 point at 24 months [P = .018]) and higher visual analog scale scores at 24 months (21.5 ± 12 vs. 7.8 ± 7.7, P = .021). Fatty infiltration of the infraspinatus was identified as an independent risk factor for retears. Patients with Goutallier grade ≥3 had significantly inferior external rotation at 3 and 6 months (26 ± 25.1° vs. 44.7 ± 11.4°, P = .032, 35 ± 28.3° vs. 53 ± 9°, P = .038) and tended to show inferior outcomes overall.

ARCR using the TR technique provides favorable clinical outcomes, even in cases with retears. However, patients with retears-especially those with large-to-massive tears or severe infraspinatus fatty infiltration-showed inferior outcomes.