Structural Musculotendinous Parameters That Predict Failed Tendon Healing After Rotator Cuff Repair

Maurits G L Olthof; Martin Flück; Paul Borbas; Paola Valdivieso; Marco Toigo; Fabian Egli; Jethin Joshy; Lukas Filli; Jess G Snedeker; Christian Gerber; Karl Wieser

doi:10.1177/23259671231196875

Structural Musculotendinous Parameters That Predict Failed Tendon Healing After Rotator Cuff Repair

Orthop J Sports Med. 2023 Sep 19;11(9):23259671231196875. doi: 10.1177/23259671231196875. eCollection 2023 Sep.

Authors

Maurits G L Olthof¹, Martin Flück², Paul Borbas¹, Paola Valdivieso², Marco Toigo², Fabian Egli^{1

3}, Jethin Joshy¹, Lukas Filli⁴, Jess G Snedeker^{1

3}, Christian Gerber¹, Karl Wieser¹

Affiliations

¹ Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
² Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Zurich, Switzerland.
³ Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
⁴ Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.

Abstract

Background: Healing of the rotator cuff after repair constitutes a major clinical challenge with reported high failure rates. Identifying structural musculotendinous predictors for failed rotator cuff repair could enable improved diagnosis and management of patients with rotator cuff disease.

Purpose: To investigate structural predictors of the musculotendinous unit for failed tendon healing after rotator cuff repair.

Study design: Cohort study; Level of evidence, 2.

Methods: Included were 116 shoulders of 115 consecutive patients with supraspinatus (SSP) tear documented on magnetic resonance imaging (MRI) who were treated with an arthroscopic rotator cuff repair. Preoperative assessment included standardized clinical and imaging (MRI) examinations. Intraoperatively, biopsies of the joint capsule, the SSP tendon, and muscle were harvested for histological assessment. At 3 and 12 months postoperatively, patients were re-examined clinically and with MRI. Structural and clinical predictors of healing were evaluated using logistic and linear regression models.

Results: Structural failure of tendon repair, which was significantly associated with poorer clinical outcome, was associated with older age (β = 1.12; 95% CI, 1.03 to 1.26; P = .03), shorter SSP tendon length (β = 0.89; 95% CI, 0.8 to 0.98; P = .02), and increased proportion of slow myosin heavy chain (MHC)-I/fast MHC-II hybrid muscle fibers (β = 1.23; 95% CI, 1.07 to 1.42; P = .004). Primary clinical outcome (12-month postoperative Constant score) was significantly less favorable for shoulders with fatty infiltration of the infraspinatus muscle (β = -4.71; 95% CI, -9.30 to -0.12; P = .044). Conversely, a high content of fast MHC-II muscle fibers (β = 0.24; 95% CI, 0.026 to 0.44; P = .028) was associated with better clinical outcome.

Conclusion: Both decreased tendon length and increased hybrid muscle fiber type were independent predictors for retear. Clinical outcome was compromised by tendon retearing and increased fatty infiltration of the infraspinatus muscle. A high content of fast MHC-II SSP muscle fibers was associated with a better clinical outcome.

Registration: NCT02123784 (ClinicalTrials.govidentifier).

Keywords: muscle atrophy; muscle fatty infiltration; muscle fiber type; predictive model; prospective cohort study; rotator cuff reconstruction.

Associated data

ClinicalTrials.gov/NCT02123784