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Prospective Longitudinal Analysis of Postoperative Shoulder Function A Ten-Year Follow-up Study of Full-Thickness Rotator Cuff Tears
Leesa M. Galatz, MD; Sean Griggs, MD; Brian D. Cameron, MD; Joseph P. Iannotti, MD, PhD
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Investigation performed at the University of Pennsylvania, Philadelphia, Pennsylvania
Leesa M. Galatz, MD
Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes Hospital Plaza, 11300 West Pavilion, St. Louis, MO 63110

Sean Griggs, MD
Houston Hand and Upper Extremity Group, 7500 Kirby Road, Houston, TX 77030

Brian D. Cameron, MD
Stevens Orthopaedic Group, 21701 76th Street, Suite 300, Edmonds, WA 98026

Joseph P. Iannotti, MD, PhD
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-41, Cleveland, OH 44195

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

A video supplement to this article is available from the Video Journal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our CD-ROM (call 781-449-9780, ext. 140, to order).

J Bone Joint Surg Am, 2001 Jul 01;83(7):1052-1056
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Abstract

Background: Rotator cuff repair is associated with good short or mid-term results, but to date there have been no long-term functional outcome studies demonstrating durability of results over time. In most long-term studies, the results have been compared with those of historical controls or with those of other, short-term follow-up studies. The purpose of the present prospective study was to evaluate short and long-term shoulder function after surgical repair in a single population of patients in order to follow changes over time.

Methods: Thirty-three patients underwent surgery, performed by one surgeon, for the treatment of a chronic, symptomatic, full-thickness rotator cuff defect. Data were obtained from questionnaires and physical examinations preoperatively, at two years, and at ten years. Identical standardized pain and function questionnaires were used and clinical evaluation was performed in a consistent fashion at all time-periods. The activity level, Constant score, level of disability, shoulder function score, and patient’s subjective rating of the outcome were determined at the time of the final follow-up and compared with the same parameters at the two-year follow-up examination in order to determine if early results change with time.

Results: At the ten-year follow-up examination, there was no change in the raw Constant score determined at the two-year examination. When the Constant score was normalized for expected age-related changes, the percentage of patients who had a satisfactory result at ten years was even greater than the percentage at two years. Activity level decreased significantly over the time-period (p = 0.005). At the final follow-up examination, twelve patients worked at the same occupation as they had when the two-year examination was performed, two worked at a less strenuous occupation, and the remaining patients were retired. Only two patients retired because of problems related to the shoulder. The level of disability decreased over the study period, and there was a small improvement in the patients’ self-assessment shoulder function score. The patients’ subjective assessment of the outcome remained unchanged.

Conclusions: The results of open rotator cuff repair for chronic tears do not deteriorate with time (ten years). The level of disability decreases, presumably because of a concurrent decrease in the activity level and in the demand on the shoulder as the patient ages. It is important to consider age-related changes when assessing the final outcome.

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    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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