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Patients' Preoperative Expectations Predict the Outcome of Rotator Cuff Repair
R. Frank HennIII, MD1; Lana Kang, MD1; Robert Z. Tashjian, MD2; Andrew Green, MD3
1 Department of Orthopaedics, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
2 Department of Orthopaedics, University of Utah School of Medicine, Orthopedic Center, 590 Wakara Way, Salt Lake City, UT 84108
3 Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Brown Medical School, Rhode Island Hospital, 2 Dudley Street, Suite 200, Providence, RI 02905. E-mail address: agshoulder@aol.com
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Sep 01;89(9):1913-1919. doi: 10.2106/JBJS.F.00358
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Background: We are not aware of any previous studies of the relationship between patients' expectations regarding rotator cuff repair and the actual outcome. We hypothesized that preoperative expectations are predictive of the outcome of rotator cuff repair.

Methods: One hundred and twenty-five patients who underwent unilateral primary repair of a chronic rotator cuff tear were included in the study. All operations were performed by a single surgeon. Each patient prospectively completed the Simple Shoulder Test (SST); the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; three visual analogue scales for shoulder pain, shoulder function, and quality of life; and the Short Form-36 (SF-36) preoperatively and at one year (mean and standard deviation, 54.1 ± 7.6 weeks) postoperatively. Preoperative expectations were quantified with use of six questions from the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) questionnaire.

Results: Greater preoperative expectations correlated with better postoperative performance on the SST, DASH, each visual analogue scale, and the SF-36 (p values ranging from <0.0001 to 0.03) as well as with greater improvement from the baseline scores on the DASH and SF-36 (p values ranging from <0.0001 to 0.018). A rigorous multivariate analysis controlling for age, gender, smoking, Workers' Compensation status, symptom duration, number of previous operations, number of comorbidities, tear size, and repair technique confirmed that greater expectations were a significant independent predictor of both better performance at one year and greater improvement on the SST, the DASH, each visual analogue scale, and the SF-36 (p values ranging from <0.001 to 0.042).

Conclusions: Patients' preoperative expectations regarding rotator cuff repair are associated with their actual self-assessed outcome. Variations in patient expectations may help to explain divergent results in published series as well as among various patient populations.

Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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