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Scientific Articles   |    
Factors Affecting Outcome After Structural Failure of Repaired Rotator Cuff Tears
Surena Namdari, MD, MSc1; Ryan P. Donegan, MD, MSc2; Aaron M. Chamberlain, MD3; Leesa M. Galatz, MD3; Ken Yamaguchi, MD, MBA3; Jay D. Keener, MD3
1 Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
2 Bluegrass Orthopaedics & Hand Care, 3480 Yorkshire Medical Park, Lexington, KY 40509
3 Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for J.D. Keener: keenerj@wudosis.wustl.edu
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A commentary by Robert Tashjian, MD, is linked to the online version of this article at jbjs.org.

Investigation performed at the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2014 Jan 15;96(2):99-105. doi: 10.2106/JBJS.M.00551
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Abstract

Background: 

Failure of structural healing is not infrequent after rotator cuff repair and often is not associated with clinical outcome. The goals of this study are to describe outcomes in a cohort of patients with a failed rotator cuff repair and to evaluate factors associated with clinical outcome.

Methods: 

This was a retrospective study of all patients with failure of structural integrity after rotator cuff surgical repair. A threshold American Shoulder and Elbow Surgeons (ASES) score of 80 points was used to allocate patients into either the successful (≥80 points; Group 1) or unsuccessful (<80 points; Group 2) cohorts. Demographics, patient-centered instruments for shoulder function, radiographic parameters, and shoulder motion were compared between groups.

Results: 

On the basis of the postoperative ASES score, thirty-three patients (54.1%) were included in Group 1 and twenty-eight patients (45.9%) were included in Group 2. Fifteen patients (53.6%) in Group 2 reported a labor-intensive occupation compared with two patients (6.1%) in Group 1 (p < 0.001). Multiple regression analysis demonstrated that labor-intensive occupation (odds ratio [OR], 202.3; p = 0.026), preoperative Simple Shoulder Test (SST) score (OR, 0.50; p = 0.028), and preoperative external rotation (OR, 0.91; p = 0.027) were associated with inclusion in Group 2. Age and other demographic variables, including sex, dominant-sided surgery, and medical comorbidities, were similar for the groups.

Conclusions: 

Successful outcomes were achieved in 54% of patients with failed rotator cuff repair. Those who self-identified their occupation as being labor-intensive represented a special group of patients who are at high risk for a poor outcome after a failed rotator cuff repair.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Peer Review 

This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

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    References

    Accreditation Statement
    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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