Understanding the Factors that Influence Success in Rotator Cuff Repair Surgery
As a sports medicine and shoulder surgeon, I perform hundreds of rotator cuff repairs each year. Rotator cuff tears vary widely—from small to large, acute to chronic—and can result from traumatic events like a fall or develop gradually due to overuse and degeneration. Deciding to perform rotator cuff repair involves evaluating numerous patient-specific and tear-specific factors. Despite careful planning, rotator cuff repair is not guaranteed to succeed, and several key factors influence outcomes. Among the various tools available to assess these risks, I often use the Rotator Cuff Healing Index (RoHI). This index provides a structured approach to discussing surgery risks with patients, supporting a shared decision-making process. Below are the three main factors associated with rotator cuff repair failure, followed by the RoHI scoring system and interpretation.
1. Tear Size
The size of the tear is one of the most critical predictors of repair success. Larger tears, particularly those with a width over 2.5 cm or retraction over 3 cm, generally have lower success rates. These extensive tears often require more complex repair and are more challenging to heal. Large, retracted tears can lead to muscle atrophy and tendon degeneration, both of which reduce the tendon’s ability to reattach and function post-surgery.
2. Tear Chronicity and Muscle Quality
The duration (or chronicity) of the tear also plays a significant role. Acute tears that are repaired shortly after injury tend to have better outcomes than chronic tears. Longstanding tears often lead to tendon retraction, muscle atrophy, and fatty infiltration, all of which reduce the chances of a successful repair. Early intervention can improve healing and shoulder function compared to delayed repairs.
3. Patient Age
Patient age is a significant factor; older patients, particularly those over 70, have a higher risk of re-tear. Age-related changes, such as reduced blood supply and cellularity within the tendons, impair healing. However, age alone should not discourage surgery, as older patients often benefit from tailored surgical techniques and post-operative care.
Rotator Cuff Healing Index (RoHI)
The Rotator Cuff Healing Index (RoHI) is a scoring system designed to predict the likelihood of successful tendon healing after rotator cuff repair. Each factor is assigned a specific point value based on its impact on healing:
- Age > 70: Assigned 2 points, as advanced age can be associated with decreased healing capacity.
- Tear Retraction > 3 cm: Given 4 points due to the increased difficulty of achieving a successful repair.
- Anteroposterior (AP) Tear Size > 2.5 cm: Assigned 2 points, as larger tear widths tend to have higher failure rates post-repair.
- Fatty Infiltration of the Infraspinatus Muscle: Scored at 3 points when present, indicating muscle degeneration and reduced healing potential.
- Bone Mineral Density (BMD) < -2.5: Given 2 points, as lower bone density can impair the tendon’s ability to reattach and heal.
- High Level of Work Activity: Assigned 2 points for patients with physically demanding jobs, as increased shoulder strain impacts healing.
The RoHI score provides a structured framework to evaluate individual risk factors. A higher score on the RoHI corresponds to a greater risk of repair failure, while a lower score indicates a better chance of successful healing. According to the original study, patients with a RoHI score of 4 points or less had a 6.0% failure rate (94% success rate), those with scores of 5 to 9 points had a 55% failure rate (45% success rate), and patients with 10 points or more had an 86% failure rate (14% success rate). This data highlights the importance of the RoHI in helping surgeons predict outcomes and guide treatment plans.
Other Contributing Factors
- Smoking: Smoking impairs tendon healing and raises the risk of complications.
- Diabetes: Diabetes increases the likelihood of re-tear due to metabolic effects on tendon strength.
Conclusion
While no scoring system can fully capture the complexity of each patient’s unique situation, the Rotator Cuff Healing Index (RoHI) offers a valuable framework for discussing the factors that influence rotator cuff repair success. It facilitates informed, shared decision-making by helping patients and surgeons understand how elements like tear size, chronicity, and age may impact surgery outcomes. Ultimately, rotator cuff repair is a personalized procedure, and consulting a shoulder specialist who can interpret these factors is essential for planning a successful surgery and recovery.
For more information on rotator cuff tears and their treatment options, please visit the dedicated page on my website here.
Citations:
- Kwon, J., Kim, S.H., Lee, Y.H., Kim, T.I., & Oh, J.H. (2019). The Rotator Cuff Healing Index: a new scoring system to predict rotator cuff healing after surgical repair. American Journal of Sports Medicine
- Manop, P., Apivatgaroon, A., Puntu, W., & Chernchujit, B. (2023). Risk Factors for Rotator Cuff Repair Failure and Reliability of the Rotator Cuff Healing Index (RoHI) in Thai Patients. The Orthopaedic Journal of Sports Medicine