Published 5/1/2008
Peter Pollack

Patient characteristics affect rotator cuff outcomes

Age and tear size are predictors for healing

Do women have worse outcomes after rotator cuff repair than men? Is surgery more successful among younger patients? What impact does tear size or use of nonsteroidal anti-inflammatory drugs (NSAIDs) have on healing? These were the questions that Barrett S. Brown, MD, and his colleagues hoped to answer with their prospective study evaluating the effect of patient characteristics on outcomes of arthroscopic treatment of rotator cuff repair.

“We found that women had lower clinical scores before surgery and at 1 year postsurgery, but by 2 years postsurgery, there was no significant difference between men and women,” reported Dr. Brown. “Patients who were taking NSAIDs at follow-up had lower functionality at 1 year postsurgery, but we found no effect on healing. The major predictors for healing were age and tear size—for each yearly increase in age, the risk for tendon retear increased by 1.08 times (p=0.006); for each centimeter increase in tear size, the risk for tendon retear increased by 2.29 (p<0.001).”>

Study parameters
Researchers prospectively followed 193 patients (mean age: 58.6 years) with rotator cuff tears at a single institution over a 3-year period. Preoperative evaluations included detailed medical history, physical examination, and completion of American Shoulder and Elbow Society (ASES) and Manual Muscle Testing questionnaires. The team also recorded patient information such as smoking history, demographics, and any use of pain medications such as narcotics and NSAIDs. The patients were evaluated postoperatively at 3 months, 1 year, and 2 years.

At the time the paper was written, 117 of the patients (71 men and 46 women) had completed 2-year follow-up.

Differences by sex, age, smoking, drug use
Mean ASES scores were lower in women than men preoperatively (44.1 vs. 57.3 [p=0.001]) and at 1-year follow-up (76.9 vs. 89.3 [p<0.001]), but at 2 years postoperative, there was no significant difference between sexes (89.5 vs. 92.7 [p>0.05]).

On the Manual Muscle Testing questionnaire, women performed worse when testing both affected and unaffected extremities preoperatively and at 1- and 2-year follow-ups (p<0.001).>

The researchers noted a significant improvement in 2-year postoperative ASES scores among patients by age. ASES scores improved from a mean of 52.6 to a mean of 91.2 among patients younger than age 65 years; among those older than 65 years, mean ASES scores improved from 48.9 to 91.7 (p<0.05). at 2-year follow-up, there was no significant difference in patient satisfaction between the two age groups (p>0.005). Forward elevation difference did approach significance at 2 years. The mean score for patients younger than age 65 years was 174.2; among those older than 65 years, it was 170.3 (p=0.074).

At a minimum 2-year follow-up, 21 patients (18.2 percent) reported pain and 19 patients reported night pain (16.7 percent). Also at 2 years, 89 patients (77.4 percent) were taking no pain medication, while 22 (19.1 percent) were taking NSAIDs and 4 (3.5 percent) were taking narcotic pain medication.

Dr. Brown’s coauthors include Shane J. Nho, MD; David W. Altchek, MD; John D. MacGillivray, MD; Frank A. Cordasco, MD; Answorth A. Allen, MD; Edward V. Craig, MD; and Russell F. Warren, MD. Disclosure information for all the authors can be found online at www.aaos.org/disclosure

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org