Long-term functional and structural outcome of rotator cuff repair in patients 60 years old or less

Andrew Green; Kelsey Loyd; Janine Molino; Peter Evangelista; Stacey Gallacher; Jacob Adkins

doi:10.1016/j.jseint.2022.10.002

Long-term functional and structural outcome of rotator cuff repair in patients 60 years old or less

JSES Int. 2022 Oct 30;7(1):58-66. doi: 10.1016/j.jseint.2022.10.002. eCollection 2023 Jan.

Authors

Andrew Green¹, Kelsey Loyd², Janine Molino³, Peter Evangelista⁴, Stacey Gallacher⁵, Jacob Adkins²

Affiliations

¹ Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
² Warren Alpert Medical School, Brown University, Providence, RI, USA.
³ Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
⁴ Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI, USA.
⁵ Advanced Orthopedics and Sports Medicine Institute, Freehold, NJ, USA.

Abstract

Background: The long-term outcomes of rotator cuff repair (RCR) have not been well studied. The purpose of this study was to evaluate long-term functional and structural outcomes after RCR in younger patients.

Methods: A total of 49 patients (34 [69%] male) with a mean age of 51 ± 6 years were evaluated preoperatively, and at short- and long-term follow-ups (minimum 15 years). There were 13 (27%) small, 17 (35%) medium, 14 (29%) large, and 5 (10%) massive tears. 15 (31%) had an acute repair of a traumatic tear. Long-term evaluation included physical examination, plain radiographs, ultrasound, and patient reported outcome measures (PROMs) (visual analog scale pain, Disability of Arm, Shoulder and Hand, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, and Short Form-36). Statistical analysis was performed to determine associations between preoperative and intraoperative factors and long-term functional and structural outcome.

Results: There were significant improvements in the mean short- and long-term PROMs compared to preoperatively that exceeded reported minimal clinically important differences and substantial clinical benefits. There was a slight decrease in the PROMs from the short-term to long-term follow-up. Male sex and traumatic rotator cuff tears were associated with better long-term outcomes. The number of medical co-morbidities was associated with worse long-term outcomes. Smaller initial tear size was associated with better long-term outcomes. There were 15 (31%) full thickness and 9 (18%) partial thickness recurrent rotator cuff tears, 17 (35%) had rotator cuff tear arthropathy (2 Hamada grade 1, 15 Hamada grade 2), 5 (10%) had revision surgery (2 revision RCR, 2 anatomic total shoulder, and 1 reverse total shoulder), and 13 (26%) had subsequent contralateral RCR. There were weak correlations between the presence of arthropathy and DASH (r = 0.34; P = .02) and visual analog scale pain (r = 0.29; P = .049). There were no significant correlations between the structural outcomes (recurrent rotator cuff tear, recurrent full thickness tear, acromiohumeral space, and critical shoulder angle,) and the PROMs.

Discussion and conclusion: Long-term follow-up of RCR in this relatively young patient cohort demonstrated substantial and durable patient reported functional outcome and improvement despite considerable structural deterioration. This suggests that while RCR does not arrest the progression of rotator cuff disease it may delay this progression and that patients adapt to the structural changes as they age.

Keywords: Long-term outcome; Natural history; Rotator cuff; Rotator cuff repair; Rotator cuff tear; Rotator cuff tear arthropathy; Structural outcome.