A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears

Abstract

Background: It is difficult to predict the arthroscopic reparability of rotator cuff tears preoperatively when the repair is challenging. This can result in unsatisfactory outcomes and a high retear rate. Purpose: To develop an assessment score reflecting factors in rotator cuff tears that can predict reparability before surgery. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively enrolled 170 patients with rotator cuff tears larger than 2 cm who underwent arthroscopic repair. Patients were categorized into "complete repair" and "partial repair" groups based on the area of the exposed footprint after arthroscopic rotator cuff repair. In each group, preoperative magnetic resonance imaging factors (tear size, fatty infiltration, remnant tendon length, atrophy), clinical factors (range of motion, American Shoulder and Elbow Surgeons score, Constant score), and patient demographics were evaluated. Receiver operating characteristic curve analysis was used to choose the optimal cutoff value. A reparability assessment score was formulated through stepwise selection using variables that showed significant between-group differences on univariate analysis. We selected 4 variables and assigned a relative score for each variable based on estimated coefficient values. The sum of the scores for each factor ranged from 0 to 5. Results: The average rotator cuff tear size was 28 x 26 mm. The torn rotator cuff was repaired completely in 74 patients (43.5%) and partially in 96 patients (56.5%). The following factors were chosen for the reparability assessment score: positive tangent sign (odds ratio [OR], 5.969;P= .001), fatty infiltration of the infraspinatus of grade <= 2 (OR, 3.537;P= .001), coronal tear size >= 26 mm (OR, 3.315;P= .002), and remnant tendon length <15 mm (OR, 2.584;P= .017). Complete repair was possible if the sum of the scores was <3 (area under curve, 0.803; 95% CI, 0.739-0.867; sensitivity, 51.0%; specificity, 95.9%). Conclusion: In patients with a score of <3 on the novel reparability assessment score, complete repair was obtainable, whereas in patients with a score of >= 3, complete repair was difficult and other methods such as biologic grafts or arthroplasty had to be considered for a favorable prognosis.