The WORC Index and Predicting Treatment Failure in Patients Undergoing Primary Arthroscopic Rotator Cuff Repair

Abstract

Background: Rotator cuff tears are common injuries that are reliably treated with arthroscopic repair, producing good to excellent results. The Western Ontario Rotator Cuff (WORC) index is a validated disease-specific instrument used to assess patient outcomes; however, no study to date has correlated WORC index with treatment failure. Purpose: To evaluate the WORC index as a predictor for successful treatment in arthroscopic rotator cuff repair. An additional purpose was to identify patient and tear characteristics associated with risk of treatment failure. Study Design: Case-control study; Level of evidence, 3. Methods: This study reviewed a total of 500 patients who underwent arthroscopic rotator cuff repair with a minimum of 2-year follow-up. Patient charts were reviewed for treatment failures, defined as persistent or recurrent shoulder pain or weakness, leading to further workup and identification of a failure to heal or recurrent tear by magnetic resonance imaging. Patient demographic and comorbidity data were gathered and correlated with risk of failure. All patients completed WORC questionnaires, and scores were correlated with risk of treatment failure. Results: There were 28 (5.6%) treatment failures at a median 28 weeks (SD, 42 weeks) postoperatively. Patients claiming workers’ compensation were 3.21 times more likely (odds ratio; P = .018) to fail treatment. Posterior interval tears (those including infraspinatus) were 3.14 times more likely ( P = .01) to fail than anterior interval tears. Tear size was associated with treatment failure; the odds of failure was 3.24 for a 2-tendon tear and 5.83 for a 3-tendon tear ( P = .03). Tears involving the nondominant arm were associated with an increased risk of failure by a factor of 3.04 (95% CI, 1.01-9.11; P = .047). A WORC score ≥80 was associated with a 95% probability of treatment success at 1 year. Conclusion: After arthroscopic rotator cuff repair, patients with WORC scores ≥80 at 1 year have a 95% probability of successful treatment and likely do not benefit from continued follow-up visits. Furthermore, several risk factors were identified that may influence outcomes after rotator cuff repair, including workers’ compensation, location of tear, tear size, and hand dominance.

A Systematic Review and Meta-analysis of Risk Factors for the Increased Incidence of Revision Surgery After Arthroscopic Rotator Cuff Repair

“…While some evidence has suggested that obesity, diabetes, and smoking status may impair tendon healing, 18,20,35 only half of the studies that evaluated these risk factors found an association with revision surgery. Of note, the study of Herring et al 22 showed trends consistent with the larger studies included in this review but was likely underpowered to detect significant differences with only 28 cases of failure in the sample. For example, 52% of failure cases had a smoking history compared with 40% of treatment success cases, and 22% of failure cases had diabetes compared with 8% of success cases.…”

Prognostic factors for improvement of shoulder function after arthroscopic rotator cuff repair: a systematic review

“…We excluded two recent studies including patients with revision repairs or nonoperative treatment. 5 , 24 Screening of the titles and abstracts of cited and citing references of included records and 18 topical records 7 , 8 , 9 , 15 , 23 , 24 , 26 , 30 , 35 , 40 , 42 , 55 , 58 , 60 , 70 , 71 , 72 , 73 did not yield any additional studies that met our inclusion criteria. A full description of included studies (studied population, outcomes, statistical analyses, and reported effect estimates) is available in Supplemental Tables 1-3 .…”

“… Unique analyses ∗ (n = 73) No. (%) Associated references Objective outcomes 14 (19) 31 , 43 , 44 , 45 Muscle strength 7 (9.5) 31 , 43 , 45 Range of motion 7 (9.5) 43 , 44 , 45 Patient-reported outcome measures 59 (81) 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 45 , 46 , 47 American Shoulder and Elbow Surgeons score 16 (22) 25 , 26 , 27 , 29 , 30 , 31 , 33 , 36 , 37 , 42 , 46 , 47 Shoulder pain …”

Effectiveness of measuring tension during arthroscopic rotator cuff repair

“…Few studies have reported concomitant SSC lesion as a risk factor for failure; however, Herring et al reported that the number of ruptured tendons correlated with failure, with an odds ratio of 5.83 for three-tendon tears [ 13 ]. We consider that even a repaired tendon whose quality and excursion could be considered satisfactory is likely to fail when the concomitant SSC condition is worse because the SSC’s superior aspect and SSP’s anterior aspect are usually continuous [ 22 ].…”