For the best clinical outcomes and low failure rates for arthroscopic rotator cuff repair, orthopedic surgeons need to carefully choose the right candidates, a new study finds.
The researchers created a predictive modeling program to help improve future patient selection, clinical decision making, and patient education in their study, “Predictive Modeling to Determine Functional Outcomes After Arthroscopic Rotator Cuff Repair,” published in the most recent issue of The American Journal of Sports Medicine.
Among the most impactful predictors of poorer outcomes in three of the models tested, the research team found, were female sex, workers’ compensation claims and previous arthroscopic rotator cuff surgery.
Patients selected for the study had received arthroscopic rotator cuff repair for full-thickness tears with at least 2 years of follow-up. The 12 predictors tested included in the patient outcome models were age, sex, workers’ compensation status, previous cuff repair, tear size, tear shape, multiple tendon involvement, tendon stump length, Goutallier classification, critical shoulder angle, length of follow-up, and baseline subjective outcomes score.
A total of 552 shoulders met inclusion criteria, but only 449 had enough postoperative data to be included in the study results. According to the data collected, the Postoperative American Shoulder and Elbow Surgeon (ASES) score improved the most from pre- to postoperative median (interquartile range): 58 (44.9-71.6) to 98.3 (89.9-100; p < .001).
Women were more likely than men to need reoperation. Other predictors of a lower ASES score were previous repair (p < .001) and workers’ compensation claim (p < .001).
Predictors for sub-optimal QuickDASH scores were presence of a worker’s compensation claim, female sex and previous incidence of repair. Significant predictors for lower SF-12 PCS (12-Item Short Form Health Survey Physical Component Summary) scores also included workers comp claims (p < .001), female sex (p = .001), and lower baseline SF-12 PCS. Last, significant independent predictors of patient satisfaction included previous arthroscopic rotator cuff repair (p = .004), workers comp claims (p = .011), female sex (p = .041), and age (p = .041).
