A Comprehensive Evaluation of Factors Affecting Healing, Range of Motion, Strength, and Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair

Abstract

Background:Rotator cuff repair (RCR) leads to improved patient outcomes, which may or may not coincide with biological healing of the tendon. Many patient factors may play a role in subjective and objective patient outcomes of surgery.Purpose:To evaluate the effect of various patient factors and tendon healing on range of motion, strength, and functional outcomes after arthroscopic RCR.Study Design:Case-control study; Level of evidence, 3.Methods:We reviewed patients who underwent arthroscopic RCR. Postoperative endpoints included physical examination, repeat magnetic resonance imaging (MRI), and patient-reported outcome measures. The Short Form–36 (SF-36) was also completed at enrollment. Physical examination included range of motion and strength testing. Preoperative tear characteristics and postoperative healing on MRI were recorded. Associations between these characteristics and rotator cuff healing were determined. Multivariate models investigated factors affecting healing and final outcomes.Results:A total of 81 patients had MRI before and a minimum of 1 year after RCR. Patient-reported outcomes were available for all patients at mean 2.7 years (range, 1-7.7 years) after RCR. Seventy-five patients had physical examination data. Patients were less likely to heal if they had tears involving multiple tendons (P = .037), tears >2.2 cm (P = .037), tears retracted >2.0 cm (P = .006), and tears with cumulative Goutallier grade ≥3 (P = .003). Patients who healed were stronger on manual muscle testing in forward elevation (P < .001) and external rotation (P = .005) and on forward elevation isometric testing (P = .033), and they reported better patient-reported outcomes (P ≤ .01) at final follow-up. In multivariate models, tendon healing was associated with less pain (P = .019) and better patient-reported outcomes (all P ≤ .006). Lower SF-36 mental component summary (MCS) score was associated with increased pain (P = .025) and lower final American Shoulder and Elbow Surgeons score (P = .035), independent of healing status.Conclusion:Larger, more retracted tears with greater fatty infiltration are less likely to heal per MRI. Patients who do not heal are weaker and have worse patient-reported outcome measures. Lower SF-36 MCS score was associated with poorer patient-reported outcomes independent of tendon healing.

Arthroscopic Superior Capsular Reconstruction With a Minimally Invasive Harvested Fascia Lata Autograft Produces Good Clinical Results

“…All patients had a preoperative cumulative Goutallier grade of ≥3. 47 Nineteen of 22 patients (86.4%) had a preoperative GFMDI of ≥2. 10 On 6-month MRI, 2 of 22 patients (9.1%) had a superior capsular graft tear (Figure 2).…”

Axillary Peripheral Nerve Stimulation for Chronic Shoulder Pain: A Retrospective Case Series

“…There is literature that clearly supports improvement in factors such as patient reported functional outcomes, pain, strength, and range of motion after common shoulder surgeries like rotator cuff repair, total shoulder arthroplasty, and reverse total shoulder arthroplasty (18)(19)(20). Having said that, not all patients are created equal when it comes to predicting outcomes after surgical intervention.…”

“…Additionally, the characteristics of the pathology in question can impact surgical success rates. For example, Wylie et al found that patients with multiple tendon tears, tears >2.2 cm, and retraction >2.0 cm were less likely to heal following arthroscopic rotator cuff repair (18). Even more so, as health care has moved away from a paternalistic physician-patient relationship and increasingly moves toward shared decision-making between providers and patients alike, many patients will simply choose not to proceed with a surgery or procedure (21).…”

Editorial Commentary: Doc, Is It All in My Head? With Rotator Cuff Tears, It Partially Is!

“…We have previously shown that tear severity (size, retraction) is not correlated with the clinical expression of rotator cuff tearing whereas mental health had the strongest correlation of any factor with baseline outcomes and was strongly associated with functional outcomes after repair. 2,3 Similarly, the decision of a patient to undergo repair versus nonoperative treatment for a chronic rotator cuff tear has very little to do with the anatomy of the tear but rather is most influenced by low patient expectations regarding the effectiveness of physical therapy. 4 Consequently, psychosocial factors including patient expectations and mental well-being likely have a tremendous influence on the clinical expression of rotator cuff tearing, the decisions to pursue treatments, and the outcomes of those treatments.…”