Original articleOutcome of rotator cuff repair*
Introduction
Not all repairs of the rotator cuff are associated with satisfactory pain relief or return of shoulder function. Realistic assessment of the likelihood of patient satisfaction is an essential component of preoperative counseling. The concepts of quality assurance and continuous improvement require measurement of surgical outcome. Surgeons are often interested in precise ranges of motion and measured return of strength. Hospital administrators and insurance officials have particular interests in length of hospital stay, cost of treatment, and time off work. Patients' main interests are in the relief of pain and restoration of ability to undertake activities of daily living (ADLs), employment, and recreation.
Numerous methods have been proposed over the last 20 years for the assessment of outcome in shoulder surgery. The importance of patients' general health and well-being and the effect of shoulder surgery on those factors is recognized.4, 5, 15, 21, 23 This study addresses a number of outcome parameters. It makes no attempt to provide an overall shoulder score but uses patient satisfaction and willingness to undergo the same surgery again as the most important indicators of successful outcome. It also reviews change in the ability to undertake specific ADLs, employment, and recreation. The study evaluates several independent nonstructural preoperative variables including patient age, sex, workers' compensation status, and revision surgery status, and how they correlate with patients' self-assessed outcome. Many structural factors including tear shape and size, tissue quality, biceps integrity, and degree of muscular atrophy may also affect the outcome of rotator cuff repair. The prognostic significance of many of these structural factors is reviewed in the second part of this study, presented in the following article. To the best of these authors' knowledge, this study represents the largest series reported to date of the outcome of repair of full-thickness rotator cuff tears by a single surgeon.
Section snippets
Material and methods
An analysis of 667 cases of repair of full-thickness rotator cuff tear performed from April 1983 to August 1996 was conducted. All surgeries were performed by one of the authors (D.H.S.). Patients were referred from a variety of sources. The tertiary referral nature of the author's practice may have produced some bias in the make-up of the patient group, with larger and more complex tears being over-represented. For obvious reasons, no realistic control group was available for this study.
Results
Of the cases reviewed, 262 (39%) were female. The average age at surgery was 59.9 years (SD, 10.1 years). The involved shoulder was the left in 29%. The operation involved the dominant extremity in 71.5%. Four percent of patients claimed to be ambidextrous. Age and sex distribution are shown in Figure 2.
Patients' main reasons for undergoing surgery are shown in Table I.Daytime pain
Discussion
The level of patient satisfaction with repair of full-thickness rotator cuff tear reached in this series is comparable to that in several other studies evaluating the outcome of rotator cuff repairs by both subjective and objective criteria.8, 10, 13, 14, 19, 26, 27 Given that pain was the most common indication for surgery, reduction in pain is clearly an important goal of surgery. In this series cuff repair was highly successful in reducing pain. The results reported here are similar to those
Summary
This study shows that, in a large series of rotator cuff repairs performed by a single, experienced shoulder surgeon, patient self-assessment of overall satisfaction, improvement in pain, and improvement in functional ability after surgery is very high. Certain subgroups of patients are less likely to report satisfactory results after surgery. These include patients on workers' compensation, those undergoing revision surgery, those younger than 55 years, or male patients. This information is
Acknowledgements
The authors acknowledge the assistance of Dr Sue Middleton, Department of Mathematics, University of New South Wales, with the statistical analyses, Mrs Fran Austin, who helped collect data, and Mrs Renee Hannan and Mrs Pam Sonnabend, who assisted enormously in preparing the manuscript.
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Reprint requests: David H. Sonnabend, FRACS, Department of Orthopaedic Surgery, Royal North Shore Hospital, St Leonards 2065 NSW, Australia.