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Patients with multiple risk factors for rotator cuff tear had less-successful arthroscopic revisions

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The size of a rotator cuff tear when it was initially repaired and the presence of an isolated risk factor for an unsatisfactory outcome, like diabetes mellitus, had little bearing on outcomes in a recent series of arthroscopic revision rotator cuff repairs.

But according to orthopedists who prospectively studied results of arthroscopic revision rotator cuff procedures in these rather challenging cases, these patients did the worst “when two or three risk factors were present,” Aaron C. Eubanks, MD, said.

Poor prognosticators of surgical success also included patients who used tobacco or were involved in a workers’ compensation case, Eubanks said at the American Society for Sports Medicine 2008 Annual Meeting.

In their study, Eubanks and colleagues closely followed the indications for revision arthroscopic surgery of the rotator cuff, which included an initial 89° forward shoulder elevation mean and a Constant shoulder score of 40 mean. They found that 46 patients from an initial group of 69 patients turned in good or excellent results at a minimum 1-year follow-up.

“We believe that arthroscopic revision cuff repair is an effective procedure,” Eubanks said.

After allowing for exclusions and re-revisions, investigators ultimately reviewed surgical results in 69 patients (39 women, 30 men), all of whom underwent arthroscopic revision rotator cuff repair surgery between 2004 and 2007.

Their mean age at the time of the revision procedure was 54 years (range 26 to 78 years).

The patients’ right shoulders were operated on in 37 cases and the left shoulder in 32 cases.

Twenty patients each used tobacco or had diabetes mellitus. Another 23 patients were involved in workers’ compensation cases.

Patients were followed for 26 months mean. Between the index and revision surgery, the repair interval was 9.7 months mean, Eubanks said.

Using shoulder motion and Constant score to assess results, investigators found final forward flexion in the group ranged from 60° to 180°, with 152° mean and the Constant scores doubled to a mean of 80 points. “The forward elevation and Constant score changes were statistically significant (P <.0001),” Eubanks added.

“We did find that the combined risk factors were statistically significant predictors of a less-successful outcome, and this is a topic that needs to be addressed with further evaluation,” he said, noting this study provides hope to patients who need rotator cuff revisions that improved shoulder function postoperatively may be possible.

For more information:

• Aaron C. Eubanks, MD, can be reached at Sarah Bush Lincoln Medical Office Pavilion, 500 Health Center Drive, Suite 101, Mattoon, IL 61938; 217- 238-3435. He has no direct financial interest in any products or companies mentioned in this article.

Reference:

• Eubanks AC, Field LD, Savoie FH, Ramsey JR. Revision arthroscopic rotator cuff repair. Presented at the American Orthopaedic Society for Sports Medicine 2008 Annual Meeting. July 10-13, 2008. Orlando, Fla.