Risk Factors Associated To Bilateral Rotator Cuff Tears And Effect Of Unilateral Rotator Cuff Repair On The Contralateral Shoulder

Objective To investigate the risk factors associated to patients with bilateral rotator cuff tears,and the effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears.Methods From 2017 to 2020,156 patients with symptomatic unilateral rotator cuff tear who met the criteria were collected,and tear size were assessed by MRI.Analyze these factors such as age,gender,body mass index,diabetes,hypercholesterolemia,hypertension,smoking history,and physical labor.According to the presence or absence of contralateral tears,they were divided into unilateral tear group and bilateral tear group.The risk factors of bilateral rotator cuff tears were compared.Use univariate analysis on the collected data.The statistically different indicators of univariate analysis were included in the Logistic regression equation,and the dual logistic regression method was used to compare the independent risk factors for the occurrence of bilateral rotator cuff tears.The 47 patients with bilateral rotator cuff tears were divided into operation group and conservative group according to different treatment methods.Among them,25patients in operation group underwent unilateral arthroscopic rotator cuff repair and contralateral conservative treatment,and 22 patients in conservative group underwent bilateral conservative treatment.Unilateral shoulder of the conservative group was selected to compare with the non-surgical shoulder of the surgical group.Before and 12months after the treatment,the tear size were measured by MRI,and the pain and function were measured by the pain visual analog scale(VAS),the University of California,Los Angeles(UCLA)shoulder function scoring system,and the United States The Association of Shoulder and Elbow Surgery Scoring System(ASES).The range of motion of the shoulder was evaluated.Observe whether the tear progression on the non-surgical side would be affected by unilateral surgery.Results Among the included 156 patients with symptomatic unilateral rotator cuff tears,47(30.1%)had contralateral tears,which were the bilateral tear group.No contralateral tear were found in 109 patients(69.9%)which were the unilateral tear group.The univariate analysis of the two groups showed that the differences in age,body mass index,physical labor and diabetes were statistically significant(P<0.05).The differences in gender,course of disease,smoking,hypercholesterolemia,and hypertension were not statistically significant(P>0.05).The logistic regression analysis of age,body mass index,physical labor and diabetes showed:high age(>60 years),high body mass index(>24kg/m~2),physical labor and diabetes were independently associated with bilateral rotator cuff tears.Of the 47 patients,25 selected unilateral rotator cuff repair.Compared with the conservative group,the tear size on the contralateral side of the surgical group was not significantly different from the tear before treatment(P>0.05);But the tear size was larger than that of conservative group at 12 months(P<0.05).The VAS score,UCLA score and ASES score of the two groups were compared before treatment,and the difference was not statistically significant(P>0.05);The score of the conservative group was better than that of operation group at 12 months(P<0.05).There was no significant difference in the range of motion of the shoulder joint between the two groups before treatment(P>0.05);the difference in the range of motion of the shoulder joint between the two groups at 12 months was not statistically significant(P>0.05).Conclusion High age(>60 years old),high body mass index(>24kg/m2),physical labor and diabetes were the risk factors for bilateral rotator cuff tear compared with unilateral rotator cuff tear,patients with unilateral rotator cuff tear who met the above indicators should prevent tears on the contralateral side.Patients with bilateral rotator cuff tears underwent unilateral rotator cuff repair.At the 12 month of follow-up,it was found that the tear on the non-operated side of surgical group was further increased and the functional score decreased compared with the conservative group.Therefore,patients with bilateral rotator cuff tears should pay more attention to the progress of contralateral tears after unilateral surgery.