Tension‐Reducing Repair Improves Rotator Cuff Healing Rates and Functional Outcomes at 2 Years

PURPOSE: To compare the effects of tension-reducing repair (footprint repositioned medially rotator cuff tears repair [FRM-RCTR] or footprint stump preserving rotator cuff tears repair [FSP-RCTR]) and full footprint covering rotator cuff tears repair (FFC-RCTR) on postoperative healing rate and shoulder function in patients with full-thickness rotator cuff tears. METHODS: A retrospective analysis was conducted on patients who received arthroscopic rotator cuff repair between July 2018 and December 2022, with ≥2 years of follow-up monitoring. Patients were allocated to surgical groups on an alternating monthly basis. The variables included demographics, medical history, tear characteristics (retraction grade, size), tension-reducing techniques (FFC-RCTR, FRM-RCTR, or FSP-RCTR), single-row or double-row suture-bridge repair techniques, and rehabilitation timelines. The outcomes included magnetic resonance imaging-based Sugaya grading (6/12/24 months), visual analog scale pain scores (1/3/6/12/24 months), and functional scores (Constant-Murley, American Shoulder and Elbow Surgeons at 3/6/12/24 months). Multivariate logistic regression identified risk factors for healing; inverse probability of treatment weighting applied to balance baseline variables between groups and generalized estimating equations were used to assess differences in outcome variables across groups. Analysis of variance and Chi-square tests were utilized for subgroup analyses prior to the implementation of inverse probability of treatment weighting. RESULTS: A total of 276 patients were included (141 with FFC-RCTR, 75 with FRM-RCTR, and 60 with footprint-preserving FSP-RCTR). The mean follow-up was 42.81 months (range, 27-67 months) for the entire cohort, with no significant difference among the groups (P = .657). Univariate analysis linked tendon retraction grade, tear size, preoperative pain, and early postoperative active exercise to the outcomes (all P < .05). Multivariate analysis confirmed Patte type 2 retraction (odds ratio (OR) = 0.071, P = .000 [95% confidence interval (CI), 0.027-0.189]), large tear size (Deorio-Cofield classification III, OR = 0.159, P = .006 [95% CI, 0.043-0.590]; Deorio-Cofield classification IV, OR = 0.030, P = .000 [95% CI, 0.008-0.109]), delayed postoperative active exercise (6-12 weeks, OR = 5.169, P = .005 [95% CI, 1.621-16.479]; >12 weeks, OR = 5.841, P = .001 [95% CI, 2.019-16.899]), and FFC-RCTR (FRM-RCTR, OR = 3.462, P = .044 [95% CI, 1.033-11.596]; FSP-RCTR, OR = 4.422, P = .019 [95% CI, 1.278-15.301]) as independent factors associated with repair failure. No significant intergroup differences were observed in pain scores at any time point or in Sugaya classification at the 6- and 12-month postoperative follow-ups. However, the tension-reducing groups presented superior Constant-Murley/American Shoulder and Elbow Surgeons scores at 6, 12, and 24 months (all P < .05) and better Sugaya grades at 24 months (all P < .05) than did the full footprint covering repair group. The proportions of cases exceeding the minimal clinically important difference were 89.9% for Constant-Murley, 89.1% for the American Shoulder and Elbow Surgeons, and 90.9% for visual analog scale. CONCLUSIONS: Compared with full footprint covering repair, tension-reducing repair increases the healing rates, and improves functional outcomes in full-thickness tears. LEVEL OF EVIDENCE: Level III, retrospective comparative case control study.