P-H Flurin1, P Hardy2, P Valenti3, N Meyer4, P Collin5, J-F Kempf6. 1. Clinique du sport Bordeaux-Mérignac, 2-4, rue Negrevergne, 33700 Mérignac, France. Electronic address: phflurin@gmail.com. 2. Hôpital Ambroise-Paré, faculté de médecine Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France. Electronic address: ph.hardy@aphp.fr. 3. Clinique Jouvenet, 6, Square Jouvenet, 75016 Paris, France. Electronic address: philippe.valenti@wanadoo.fr. 4. Faculté de médecine, laboratoire de biostatistique et informatique médicale, 4, rue Kirschleger, 67085 Strasbourg cedex, France. Electronic address: nm3141593@gmail.com. 5. Centre hospitalier privé de Saint-Grégoire, 6, boulevard de la Boutière, 35768 Saint-Grégoire, France. Electronic address: collin.ph@wanadoo.fr. 6. Centre de chirurgie orthopédique et de la main, avenue Baumann, 67400 Illkirch-Graffenstaden, France. Electronic address: Jean-Francois.Kempf@chru-strasbourg.fr.
Abstract
BACKGROUND: Joint surgery is often complicated by gradual bone and cartilage deterioration that eventually leads to secondary osteoarthritis. The primary objective of this study was to identify preoperative risk factors for gleno-humeral osteoarthritis after rotator cuff repair. The secondary objectives were to assess whether the risk of gleno-humeral osteoarthritis was influenced by the operative technique, occurrence of postoperative complications, cuff healing, and muscle degeneration and to determine whether gleno-humeral osteoarthritis affected the clinical outcome. HYPOTHESIS: The development of gleno-humeral osteoarthritis affects the postoperative clinical outcome. MATERIAL AND METHOD: A retrospective multicentre study of patients who underwent rotator cuff repair in 2003 and were re-evaluated at least 10 years later was conducted under the aegis of the Société française de chirurgie orthopédique et traumatique (SOFCOT). Osteoarthritis severity was graded according to the Samilson-Prieto classification. RESULTS: Four hundred and one patients were included. At last follow-up, at least 10 years after surgery, the radiological Samilson-Prieto grades were distributed as follows: 0, n=181 (45%); 1, n=142 (n=35%); 2, n=57 (14%); 3, n=14 (4%); and 4, n=7 (2%). The mean Constant score was significantly higher in the patients without than with osteoarthritis at last follow-up (79/100 vs. 73/100, P<0.001). MRI assessment of cuff healing showed that the proportion of patients with osteoarthritis was significantly higher in the group with unhealed or re-torn cuffs (Sugaya type 4 or 5) than in the group with healed cuffs (Sugaya type 1, 2, or 3) (46% vs. 25%, P=0.012). DISCUSSION: Our study showed no associations linking the risk of gleno-humeral osteoarthritis to the patient activity profile, history of shoulder injury, or preoperative symptom duration. In contrast, statistically significant associations were identified between gleno-humeral osteoarthritis and age, male gender, initial tear severity, and the pain and mobility components of the preoperative Constant score. Decreased invasiveness of the operative technique probably diminishes the long-term risk of osteoarthritis. An unhealed or re-torn cuff increases the risk of osteoarthritis. Osteoarthritis is associated with poorer final clinical outcomes. LEVEL OF EVIDENCE: IV, retrospective non-randomised study.
BACKGROUND: Joint surgery is often complicated by gradual bone and cartilage deterioration that eventually leads to secondary osteoarthritis. The primary objective of this study was to identify preoperative risk factors for gleno-humeral osteoarthritis after rotator cuff repair. The secondary objectives were to assess whether the risk of gleno-humeral osteoarthritis was influenced by the operative technique, occurrence of postoperative complications, cuff healing, and muscle degeneration and to determine whether gleno-humeral osteoarthritis affected the clinical outcome. HYPOTHESIS: The development of gleno-humeral osteoarthritis affects the postoperative clinical outcome. MATERIAL AND METHOD: A retrospective multicentre study of patients who underwent rotator cuff repair in 2003 and were re-evaluated at least 10 years later was conducted under the aegis of the Société française de chirurgie orthopédique et traumatique (SOFCOT). Osteoarthritis severity was graded according to the Samilson-Prieto classification. RESULTS: Four hundred and one patients were included. At last follow-up, at least 10 years after surgery, the radiological Samilson-Prieto grades were distributed as follows: 0, n=181 (45%); 1, n=142 (n=35%); 2, n=57 (14%); 3, n=14 (4%); and 4, n=7 (2%). The mean Constant score was significantly higher in the patients without than with osteoarthritis at last follow-up (79/100 vs. 73/100, P<0.001). MRI assessment of cuff healing showed that the proportion of patients with osteoarthritis was significantly higher in the group with unhealed or re-torn cuffs (Sugaya type 4 or 5) than in the group with healed cuffs (Sugaya type 1, 2, or 3) (46% vs. 25%, P=0.012). DISCUSSION: Our study showed no associations linking the risk of gleno-humeral osteoarthritis to the patient activity profile, history of shoulder injury, or preoperative symptom duration. In contrast, statistically significant associations were identified between gleno-humeral osteoarthritis and age, male gender, initial tear severity, and the pain and mobility components of the preoperative Constant score. Decreased invasiveness of the operative technique probably diminishes the long-term risk of osteoarthritis. An unhealed or re-torn cuff increases the risk of osteoarthritis. Osteoarthritis is associated with poorer final clinical outcomes. LEVEL OF EVIDENCE: IV, retrospective non-randomised study.
Authors: Lynn Ann Forrester; Fei Fang; Timothy Jacobsen; Yizhong Hu; Iden Kurtaliaj; Benjamin D Roye; X Edward Guo; Nadeen O Chahine; Stavros Thomopoulos Journal: J Orthop Res Date: 2021-12-03 Impact factor: 3.102