Predicting rotator cuff retear after arthroscopic repair: a lipoprotein-based model.

Abstract

Rotator cuff tear is the most common tendon injury. Currently, arthroscopic rotator cuff repair (ARCR) is the primary method for diagnosing and treating rotator cuff tear. One of the major complications following ARCR is retear. This study aims to evaluate the correlation between systemic lipid metabolism and retear occurrence after ARCR through a retrospective analysis of postoperative patients. This retrospective study reviewed consecutive patients of a single surgeon who underwent ARCR from January 2021 to January 2022. Eligibility for inclusion required complete sequential follow-up data, encompassing preoperative laboratory tests and a series of postoperative magnetic resonance imaging (MRI) evaluations at 1, 2, 3, and 6 months. Exclusion criteria included patients with incomplete laboratory tests, a history of tumors, prior shoulder surgeries, isolated subscapularis tendon tears, the rotator cuff related muscles are not clearly or completely displayed in MRI, absence of follow-up MRI, or those under treatment with lipid-lowering medications. Logistic regression analysis was employed to identify preoperative factors associated with retear, with statistical significance adjudged at P < .05. From the initial cohort of 400 patients who underwent ARCR during the study period, 202 met both inclusion and exclusion criteria. These patients were subsequently divided into a training group (n = 122) and a test group (n = 80), maintaining a ratio of 6:4. Statistical analysis revealed significant risk factors for post-ARCR retear including high body mass index (>27.1; odds ratio (OR): 5.994, 95% confidential interval (CI): 1.762-13.980; P = .042), subscapularis muscle fatty infiltration of Grades 3 and 4 (OR: 8.509, 95%CI: 3.811-17.702; P = .009), serum apolipoprotein B (ApoB) levels exceeding 1.4 g/L (OR: 9.658, 95%CI: 3.520-21.753; P = .028), and an ApoB/A1 ratio greater than 1.8 (OR: 5.098, 95%CI: 1.787-10.496; P = .016). Conversely, the serum high-density lipoprotein level above 1.2 mmol/L (OR: -3.342, 95%CI: -7.466 to 0.659; P = .039) served as a protective factor. The model incorporating these 5 factors predicted retear with a sensitivity of 78.3% and specificity of 98.0% (area under the curve = 0.924, accuracy = 90.3%). Moreover, a new model comprising 3 lipid metabolism-related factors including high-density lipoprotein, ApoB and the ApoB/A1 ratio showed a sensitivity of 80.5% and specificity of 83.2% (area under the curve = 0.866, accuracy = 85.8%) for predicting retear after ARCR. A predictive model utilizing key systemic lipid metabolism markers including HDL, ApoB, and the ApoB/A1 ratio, demonstrates effective forecasting of retear incidence following ARCR.