Nasuhi ALTAY, Fatih Emre TOPSAKAL, Ekrem ÖZDEMİR, Esra DEMİREL
Journal of Health Sciences and Medicine - 2026;9(3):608-614
Aims: The aim of this study was to identify the comorbidities that most strongly influence re-rupture following arthroscopic rotator cuff repair (RCR) and to determine the independent risk contributions of age, diabetes mellitus, bone mineral density (BMD), tear size, and retraction. Methods: A total of 481 patients who underwent primary arthroscopic full-thickness RCR between February 2020 and June 2024 were retrospectively reviewed; after exclusions, 392 patients were included. Demographic variables, comorbidities (diabetes mellitus, smoking, obesity, hypercholesterolemia), BMD, tear size, retraction, and fatty infiltration were collected from preoperative records. Functional outcomes were assessed with Visual Analog Scale (V AS), American Shoulder and Elbow Surgeons (ASES) and Constant scores. Re-rupture was confirmed by postoperative magnetic resonance imaging (MRI) and clinical functional loss. Risk factors were analyzed using univariate and multivariate logistic regression. Results: The re-rupture rate was 18.6% (73/392). Patients with re-rupture had significantly larger tears (38.9+/-9.2 mm, p<0.001), greater retraction (24.8+/-7.5 mm, p<0.001), and lower BMD (T-score -2.1+/-1.8, p<0.001). In multivariate analysis, DEXA <-2 [adjusted OR (aOR) 22.51, p<0.001], diabetes mellitus (aOR 10.52, p<0.001), age >65 years (aOR 5.67, p<0.001), and large/massive tears (aOR 11.84, p<0.001) were identified as independent predictors of re-rupture. The model demonstrated excellent discrimination with an area under the curve (AUC) of 0.927. Postoperative ASES (64.5), constant (62.8), and V AS (4.8) scores were significantly worse in the re-rupture group. Conclusion: Re-rupture after arthroscopic RCR is significantly associated with older age, diabetes mellitus, low bone mineral density, and large/massive tears. Among these, DEXA <-2 and diabetes mellitus emerge as the strongest determinants of structural healing. Detailed preoperative risk profiling may enable optimization of surgical planning and personalized rehabilitation strategies for high-risk patients.
