Obesity causes poorer clinical results and higher re-tear rates in rotator cuff repair

  • A. Ateschrang
  • F. Eggensperger
  • M. D. Ahrend
  • S. Schröter
  • U. Stöckle
  • Tobias M. Kraus
Arthroscopy and Sports Medicine
  • 29 Downloads

Abstract

Background

The purpose of this retrospective study was to report on the functional outcome after both open and arthroscopic rotator cuff (RC) repair in normal weight, pre-obese and obese patients. It was hypothesized that obesity is a negative prognostic factor for clinical outcome and failure for the RC repair.

Methods

One hundred and forty-six patients who underwent either open or arthroscopic rotator cuff repair between 2006 and 2010 were included in this study. Seventy-five patients (56.7 ± 10.1 years of age) after open RC repair and 71 patients (59.0 ± 9.1 years of age) treated arthroscopically were available for evaluation. In both groups a double-row reconstruction was performed. Patients were divided in three groups according to their body-mass index. The mean follow-up was at 43 ± 16 (minimum 24) months. At follow-up, the clinical outcome was assessed by the DASH and Constant score. An ultrasound of both shoulders was performed in all patients.

Results

The mean BMI was 28.3 ± 5.3 in the arthroscopic group and 27.7 ± 4.3 in the open group. Overall, in both groups similar clinical results were noted [Constant–Murley score 78.3 ± 18.2 arthroscopic vs. 77.0 ± 21.8 for open surgery; DASH 12.7 ± 18.2 arthroscopic vs. 15.6 ± 21.6 for open surgery (p = 0.81)]. Both the failure rate and the clinical outcome were significantly worse for obese patients (BMI > 30, p = 0.007). The failure rate was 15.8% for the normal-weight patients, 8.2% in the pre-obese group and in the obese group 28.6%. The RC repair failure occurred in 11 cases in both groups after arthroscopic or open treatment (15.0%).

Conclusions

Both the arthroscopic and the open approach showed equivalent clinical results and failure rates. Obesity (BMI > 30) causes less favorable results in the Constant and DASH scores and showed higher re-tear rates.

Keywords

Rotator cuff repair Rotator cuff failure Obesity BMI 

References

  1. 1.
    Bhatia S, Greenspoon JA, Horan MP, Warth RJ, Millett PJ (2015) Two-year outcomes after arthroscopic rotator cuff repair in recreational athletes older than 70 years. Am J Sports Med 43(7):1737–1742CrossRefPubMedGoogle Scholar
  2. 2.
    Mascarenhas R, Chalmers PN, Sayegh ET, Bhandari M, Verma NN, Cole BJ, Romeo AA (2014) Is double-row rotator cuff repair clinically superior to single-row rotator cuff repair: a systematic review of overlapping meta-analyses. Arthroscopy 30(9):1156–1165CrossRefPubMedGoogle Scholar
  3. 3.
    Pauly S, Stahnke K, Klatte-Schulz F, Wildemann B, Scheibel M, Greiner S (2015) Do patient age and sex influence tendon cell biology and clinical/radiographic outcomes after rotator cuff repair? Am J Sports Med 43(3):549–556CrossRefPubMedGoogle Scholar
  4. 4.
    Charousset C, Bellaiche L, Kalra K, Petrover D (2010) Arthroscopic repair of full-thickness rotator cuff tears: is there tendon healing in patients aged 65 years or older? Arthroscopy 26(3):302–309CrossRefPubMedGoogle Scholar
  5. 5.
    Loew M, Magosch P, Lichtenberg S, Habermeyer P, Porschke F (2015) How to discriminate between acute traumatic and chronic degenerative rotator cuff lesions: an analysis of specific criteria on radiography and magnetic resonance imaging. J Shoulder Elbow Surg 24(11):1685–1693CrossRefPubMedGoogle Scholar
  6. 6.
    Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB (1995) Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Jt Surg Am 77(1):10–15CrossRefGoogle Scholar
  7. 7.
    Brockmeyer M, Schmitt C, Haupert A, Kohn D, Lorbach O (2017) Limited diagnostic accuracy of magnetic resonance imaging and clinical tests for detecting partial-thickness tears of the rotator cuff. Arch Orthop Trauma Surg 137(12):1719–1724CrossRefPubMedGoogle Scholar
  8. 8.
    Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CW, Gerber C (2007) Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Jt Surg Am 89(9):1928–1934Google Scholar
  9. 9.
    Severud EL, Ruotolo C, Abbott DD, Nottage WM (2003) All-arthroscopic versus mini-open rotator cuff repair: a long-term retrospective outcome comparison. Arthroscopy 19(3):234–238CrossRefPubMedGoogle Scholar
  10. 10.
    Walton JR, Murrell GA (2012) A two-year clinical outcomes study of 400 patients, comparing open surgery and arthroscopy for rotator cuff repair. Bone Jt Res 1(9):210–217CrossRefGoogle Scholar
  11. 11.
    Bayle X, Pham TT, Faruch M, Gobet A, Mansat P, Bonnevialle N (2017) No difference in outcome for open versus arthroscopic rotator cuff repair: a prospective comparative trial. Arch Orthop Trauma Surg 137(12):1707–1712CrossRefPubMedGoogle Scholar
  12. 12.
    Millett PJ, Espinoza C, Horan MP, Ho CP, Warth RJ, Dornan GJ, Christoph Katthagen J (2017) Predictors of outcomes after arthroscopic transosseous equivalent rotator cuff repair in 155 cases: a propensity score weighted analysis of knotted and knotless self-reinforcing repair techniques at a minimum of 2 years. Arch Orthop Trauma Surg 137(10):1399–1408CrossRefPubMedGoogle Scholar
  13. 13.
    McElvany MD, McGoldrick E, Gee AO, Neradilek MB, Matsen FA 3rd (2015) Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med 43(2):491–500CrossRefPubMedGoogle Scholar
  14. 14.
    Djerbi I, Chammas M, Mirous MP, Lazerges C, Coulet B, French Society For S, Elbow (2015) Impact of cardiovascular risk factor on the prevalence and severity of symptomatic full-thickness rotator cuff tears. Orthop Traumatol Surg Res 101 (6 Suppl):S269-273Google Scholar
  15. 15.
    Saccomanno MF, Sircana G, Cazzato G, Donati F, Randelli P, Milano G (2015) Prognostic factors influencing the outcome of rotator cuff repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 24 (12):3809–3819CrossRefPubMedGoogle Scholar
  16. 16.
    Kim YK, Moon SH, Cho SH (2013) Treatment outcomes of single- versus double-row repair for larger than medium-sized rotator cuff tears: the effect of preoperative remnant tendon length. Am J Sports Med 41(10):2270–2277CrossRefPubMedGoogle Scholar
  17. 17.
    Stahnke K, Nikulka C, Diederichs G, Haneveld H, Scheibel M, Gerhardt C (2016) Serial MRI evaluation following arthroscopic rotator cuff repair in double-row technique. Arch Orthop Trauma Surg 136(5):665–672CrossRefPubMedGoogle Scholar
  18. 18.
    Kovacevic D, Rodeo SA (2008) Biological augmentation of rotator cuff tendon repair. Clin Orthop Relat Res 466(3):622–633CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Cheung EV, Silverio L, Sperling JW (2010) Strategies in biologic augmentation of rotator cuff repair: a review. Clin Orthop Relat Res 468(6):1476–1484CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rodeo SA (2007) Biologic augmentation of rotator cuff tendon repair. J Shoulder Elbow Surg 16(5 Suppl):S191-197Google Scholar
  21. 21.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res (304):78–83Google Scholar
  22. 22.
    Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67(3):264–268CrossRefPubMedGoogle Scholar
  23. 23.
    Park JS, Park HJ, Kim SH, Oh JH (2015) Prognostic factors affecting rotator cuff healing after arthroscopic repair in small to medium-sized tears. Am J Sports Med 43(10):2386–2392CrossRefPubMedGoogle Scholar
  24. 24.
    Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res (254):81–86Google Scholar
  25. 25.
    Chung SW, Oh JH, Gong HS, Kim JY, Kim SH (2011) Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors. Am J Sports Med 39(10):2099–2107CrossRefPubMedGoogle Scholar
  26. 26.
    Whiting PS, White-Dzuro GA, Avilucea FR, Dodd AC, Lakomkin N, Obremskey WT, Collinge CA, Sethi MK (2017) Body mass index predicts perioperative complications following orthopaedic trauma surgery: an ACS-NSQIP analysis. Eur J Trauma Emerg Surg 43(2):255–264CrossRefPubMedGoogle Scholar
  27. 27.
    Romero-Corral A, Somers VK, Sierra-Johnson J, Thomas RJ, Collazo-Clavell ML, Korinek J, Allison TG, Batsis JA, Sert-Kuniyoshi FH, Lopez-Jimenez F (2008) Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes 32(6):959–966CrossRefGoogle Scholar
  28. 28.
    Roy JS, Braen C, Leblond J, Desmeules F, Dionne CE, MacDermid JC, Bureau NJ, Fremont P (2015) Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med 49(20):1316–1328CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Collin P, Yoshida M, Delarue A, Lucas C, Jossaume T, Ladermann A, French Society for S Elbow (2015) Evaluating postoperative rotator cuff healing: prospective comparison of MRI and ultrasound. Orthop Traumatol Surg Res 101(6 Suppl):S265–S268CrossRefPubMedGoogle Scholar
  30. 30.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res (214):160–164Google Scholar
  31. 31.
    Balke M, Banerjee M, Vogler T, Akoto R, Bouillon B, Liem D (2014) Acromial morphology in patients with calcific tendinitis of the shoulder. Knee Surg Sports Traumatol Arthrosc 22 (2):415–421CrossRefPubMedGoogle Scholar
  32. 32.
    Nicholson GP, Goodman DA, Flatow EL, Bigliani LU (1996) The acromion: morphologic condition and age-related changes. A study of 420 scapulas. J Shoulder Elbow Surg 5(1):1–11CrossRefPubMedGoogle Scholar
  33. 33.
    Doyscher R, Kraus K, Finke B, Scheibel M (2014) Acute and overuse injuries of the shoulder in sports. Der Orthop 43(3):202–208CrossRefGoogle Scholar
  34. 34.
    Beitzel K, Zandt JF, Buchmann S, Beitzel KI, Schwirtz A, Imhoff AB, Brucker PU (2016) Structural and biomechanical changes in shoulders of junior javelin throwers: a comprehensive evaluation as a proof of concept for a preventive exercise protocol. Knee Surg Sports Traumatol Arthrosc 24(6):1931–1942CrossRefPubMedGoogle Scholar
  35. 35.
    Gumina S, Candela V, Passaretti D, Latino G, Venditto T, Mariani L, Santilli V (2014) The association between body fat and rotator cuff tear: the influence on rotator cuff tear sizes. J Shoulder Elbow Surg 23(11):1669–1674CrossRefPubMedGoogle Scholar
  36. 36.
    Gumina S, Arceri V, Carbone S, Albino P, Passaretti D, Campagna V, Fagnani C, Postacchini F (2013) The association between arterial hypertension and rotator cuff tear: the influence on rotator cuff tear sizes. J Shoulder Elbow Surg 22(2):229–232CrossRefPubMedGoogle Scholar
  37. 37.
    Kim YK, Jung KH, Kim JW, Kim US, Hwang DH (2017) Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: a retrospective cohort study. J Shoulder Elbow Surg.  https://doi.org/10.1016/j.jse.2017.11.016 Google Scholar
  38. 38.
    Warrender WJ, Brown OL, Abboud JA (2011) Outcomes of arthroscopic rotator cuff repairs in obese patients. J Shoulder Elbow Surg 20(6):961–967CrossRefPubMedGoogle Scholar
  39. 39.
    Abtahi AM, Granger EK, Tashjian RZ (2015) Factors affecting healing after arthroscopic rotator cuff repair. World J Orthop 6(2):211–220CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Dhar Y, Anakwenze OA, Steele B, Lozano S, Abboud JA (2013) Arthroscopic rotator cuff repair: impact of diabetes mellitus on patient outcomes. Physician Sports Med 41(1):22–29CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • A. Ateschrang
    • 1
  • F. Eggensperger
    • 1
  • M. D. Ahrend
    • 1
    • 2
  • S. Schröter
    • 1
  • U. Stöckle
    • 1
  • Tobias M. Kraus
    • 1
  1. 1.BG Trauma Center TübingenEberhard-Karls-Universität TübingenTübingenGermany
  2. 2.AO Research InstituteDavosSwitzerland

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