JSES - 2026-04-24 - Journal Article
Tendon Stump Tendinosis and Combined Subscapularis Tear as Risk Factors for Healing Failure After Medium-Sized Rotator Cuff Repair.
Kim JH, Kwon YU, Kim DY, Jung SH, Kang HG, Park JH
Topics
Key Takeaway
A preoperative MRI C/D signal ratio (tendon stump/deltoid) ≥1.09 independently predicts healing failure after medium-sized rotator cuff repair with an AUC of 0.82 and adjusted OR of 11.5.
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Summary
This single-center retrospective cohort evaluated preoperative MRI tendon stump characteristics and concomitant subscapularis tear grade as predictors of healing failure (Sugaya types 4–5) after primary ARCR for medium-sized tears in 136 patients. Univariable analysis identified C signal intensity, C/D ratio, stump thickness, and subscapularis tear grade as significant risk factors; multivariable logistic regression retained only the C/D ratio (adjusted OR 11.518, p<0.001) with a cutoff of 1.09 (AUC 0.82). Subscapularis tear grade did not survive multivariable adjustment, suggesting its effect is confounded by stump signal quality.
Key Limitation
The postoperative MRI timing is not specified, making it impossible to determine whether the C/D ratio predicts early biological failure versus late mechanical retear.
Original Abstract
PURPOSE
While age, tear size, and fatty infiltration are established prognostic indicators for arthroscopic rotator cuff repair (ARCR), little is known about the impact of tendon stump status and concomitant subscapularis tears on healing, especially in medium-sized tears. This study aimed to evaluate their impact on tendon healing following arthroscopic repair of medium-sized rotator cuff tears.
METHODS
This single-center retrospective cohort study included 136 patients who underwent primary arthroscopic rotator cuff repair (ARCR) for medium-sized tears between June 2019 and October 2022. Patients were classified into healing (Sugaya types 1-3) and non-healing (types 4-5) groups based on postoperative MRI findings. Preoperative tendon stump characteristics-including signal intensity of the tendon stump (C signal), C/D signal ratio (tendon stump signal / deltoid muscle signal), tendon stump thickness, remnant tendon length, delamination, and anterior cable involvement-were evaluated on preoperative MRI and intraoperative findings. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors for healing failure.
RESULTS
Univariable logistic regression analysis identified C signal intensity, C/D signal ratio, tendon stump thickness and subscapularis tear grade as significant risk factors for non-healing (all p < 0.05). Only the C/D ratio remained independently associated in the multivariable model(adjusted OR 11.518, p < 0.001). Cutoff value for C/D ratio was 1.09 (AUC 0.82, p < 0.001).
CONCLUSION
Quantitative MRI assessment of tendon stump tendinosis using C/D ratio is strongly associated with ARCR healing in medium-sized tears. Comprehensive preoperative evaluation of both tendon stump quality and subscapularis integrity may inform surgical planning and improve prognosis for medium-sized tears.