The role of medical comorbidities in rotator cuff retear after arthroscopic repair: a TriNetX database review of 98,844 patients

Background: Arthroscopic rotator cuff repair (ARCR) is the most common form of operative intervention utilized in the treatment of rotator cuff tears. Retear rates following ARCR have been reported to range from 7% to 94%. This study was undertaken to better understand the effects of various medical comorbidities and age on rotator cuff retear risk following ARCR. Methods: The TriNetX US Collaborative Network was queried for all patients treated with ARCR from 2013 to 2022 with recurrence of rotator cuff tear within 1 year. Cohorts were defined by inclusion of medical comorbidities at time of ARCR including hypertension, hyperlipidemia, chronic ischemic heart disease, type 2 diabetes mellitus, smoking history, and chronic kidney disease. Patient age groups in 10-year increments were also examined. Propensity score matching was performed for comorbid groups to adjust for age and comorbidities. Relative risk was calculated for each comorbidity and age group. Results: There were a total of 98,844 patients who underwent ARCR for complete rotator cuff tear from 2012 to 2023 with an overall retear percentage of 16.3% within 1 year of surgery. Hypertension, hyperlipidemia, and smoking history were significant risk factors of retear after propensity score matching. Chronic ischemic heart disease, chronic kidney disease, and type 2 diabetes mellitus were not significant risk factors of retear after propensity score matching. It was also noted that relative risk of retear increased as patient age increased; patients aged 81-90 having the highest likelihood of retear (relative risk: 1.206), with a retear rate of 19.6%. Conclusion: Medical comorbidities and advanced age can increase the risk of rotator cuff retear following ARCR. Understanding how these common comorbidities affect retear rate following ARCR can better inform orthopedic surgeons of potential risks and optimize postoperative outcomes.