Remnant preservation improves early prognosis in patients with rotator cuff tears: a retrospective study

There is still debate regarding whether the remnant tendon on the greater tuberosity should be removed during rotator cuff repair (RCR). This study aimed to evaluate whether remnant preservation (RP) in RCR leads to better clinical outcomes.

Medical records of 833 consecutive patients with rotator cuff tears (RCTs) between December 2019 and April 2022 were retrospectively reviewed. Patients were divided into a RP group and a conventional repair (CR) group, and 1:1 propensity score matching was performed based on age, sex, tear size, tear type, repair method, and fatty infiltration. After matching, 33 patients were included in each group. Clinical outcomes were compared using range of motion (ROM), visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, University of California-Los Angeles (UCLA) score, Simple Shoulder Test (SST) score, and the Quick Disabilities of the Arm, Shoulder, and Hand (quick-DASH) score preoperatively and at 3 months, 6 months, and final follow-up. Magnetic resonance imaging (MRI) was performed at the final follow-up to evaluate the integrity of the repaired rotator cuff tendons.

The mean patient age was 56.6 ± 7.7 years in RP group and 56.8 ± 7.8 in CR group, with an average follow-up of 29.5 ± 4.2 months. The mean MRI follow-up time was also 29.5 ± 4.2 months. Final follow-up scores were higher than preoperative scores in both groups. There were no significant differences between the two groups in final follow-up scores for any assessment. However, at 3 and 6 months postoperatively, the RP group showed better functional scores on ASES, Constant-Murley, SST, and Quick-DASH compared to the CR group. Additionally, at 3 months postoperatively, the RP group had better VAS scores. In patients with acute tears, the differences in ASES, Constant-Murley, SST, and VAS scores between the groups were even more pronounced. The RP group also showed superior flexion, external rotation, and internal rotation at 3 and 6 months postoperatively, with no differences before surgery or at the final follow-up. Regarding abduction, the RP group had a greater angle at 6 months and at the final follow-up. There were no statistically significant differences in retear rates between the groups, although the RP group demonstrated better quality of the repaired rotator cuff.

Both groups showed improved outcomes compared to preoperative scores at final follow-up, with no differences between groups at that time point. RP repair improved early clinical outcomes and resulted in better quality of the repaired rotator cuff compared to CR.