JSES - 2026-03-13 - Journal Article
Older Age, Longer Symptom Duration, and Larger Sagittal Tear Size Predict Poorer Outcomes After Margin Convergence Repair of Massive Rotator Cuff Tears.
Oklaz EB, Ahmadov A, Aral F, Korkut SB, Ozturk H, Ayas IH, Sezgin EA, Kanatli U
Topics
Key Takeaway
After arthroscopic margin convergence repair for massive rotator cuff tears, 68–83% of patients achieved MCID on ASES, but older age, longer symptom duration, and larger sagittal tear size independently reduced odds of reaching PASS and SCB.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective case series evaluated MCID, SCB, and PASS achievement rates and their predictors in 60 patients undergoing arthroscopic partial margin convergence repair for massive rotator cuff tears between 2014 and 2023. ASES MCID, PASS, and SCB thresholds were 24.5, 69.0, and 41.5, achieved by 83%, 75%, and 68% of patients respectively. Regression analysis identified older age as reducing odds of achieving MCID, PASS, and SCB, while larger sagittal tear size and longer symptom duration specifically reduced odds of reaching PASS and SCB.
Key Limitation
The small sample size of 60 patients limits the statistical power of the regression models and the precision of the derived MCID/PASS/SCB thresholds.
Original Abstract
BACKGROUND
Margin convergence repair is a technique that embraces the philosophy of "harnessing the ox rather than roping the bull" for the repair of massive rotator cuff tears and has been shown to provide satisfactory functional outcomes. However, previous studies have generally relied on traditional scoring systems, leaving the clinical relevance of the outcomes from the patient's perspective and the effect of patient characteristics on these results largely unknown. Therefore, this study aimed to evaluate the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) in patients who underwent arthroscopic margin convergence repair for massive rotator cuff tears and to analyze the impact of patient-related factors on functional recovery.Regarding predictors, we hypothesized that patients with older age and larger sagittal tear size would be less likely to achieve clinically meaningful outcomes.
METHODS
This retrospective case series study was conducted on patients who underwent arthroscopic repair for massive rotator cuff tears between 2014 and 2023. Patients who underwent partial margin convergence repair using a combination of tendon-to-tendon sutures and anchor fixation were included in the study. The evaluation comprised the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), Visual Analog Scale (VAS), and Range of Motion (ROM) measurements. The proportion of patients who achieved the thresholds for the MCID, SCB, and PASS were identified based on the ASES, SSV, and VAS. Regression analysis was conducted to determine the predictors of achieving these thresholds.
RESULTS
The study included 60 patients (mean age 62.5 ± 9.2 years; mean follow-up 66.0 ± 36.1 months). The thresholds for MCID, PASS, and SCB were 24.5, 69.0, 41.5 for ASES; 25.0, 62.5, 32.5 for SSV; and 2.0, 2.5, 4.5 for VAS, respectively. The proportions of patients who achieved these thresholds were as follows: ASES (83%, 75%, 68%), SSV (78%, 73%, 72%), and VAS (83%, 77%, 63%). Older age was associated with lower odds of achieving MCID, PASS, and SCB, similarly a larger sagittal tear size and longer symptom duration reduced the odds of reaching PASS and SCB.
CONCLUSION
Partial repair using the margin convergence procedure is an effective treatment for massive rotator cuff tears, with the majority of patients achieving clinically meaningful outcomes at a minimum follow-up of two years. Lower rates of clinical success can be expected in patients with older age, longer symptom duration, and larger sagittal tear size.