Older age, longer symptom duration, and larger sagittal tear size predict poorer outcomes after margin convergence repair of massive rotator cuff tears

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. 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. 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, and 41.5 for ASES; 25.0, 62.5, and 32.5 for SSV; and 2.0, 2.5, and 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. 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 2 years. Lower rates of clinical success can be expected in patients with older age, longer symptom duration, and larger sagittal tear size.