Better preoperative outcome measures may increase functional outcome after rotator cuff repair

Julie Bishop, MD

This Norwegian study evaluated a cohort of 733 consecutive patients treated with arthroscopic rotator cuff repair at a single institution with a minimum 2-year follow-up to determine the prognostic factors influencing functional outcomes.  In total, they had 2-year follow-up functional outcome scores on 647 patients (88%). They collected standard baseline patient, radiographic and perioperative data, as well as preoperative and postoperative Western Ontario Rotator Cuff Index (WORC) scores and preoperative Constant-Murley scores in both shoulders.

When they applied a multivariable regression analysis, they found that the strongest predictors of shoulder function 2 years after rotator cuff repair were a better preoperative WORC and better Constant-Murley score in the contralateral shoulder. It is not surprising that the better function one has prior to surgery, the better the potential postoperative function. However, it is surprising that function in the opposite shoulder was a strong predictor of functional outcomes. The authors suggest that this could relate to more severe degenerative cuff disease in both shoulders, but more work can be done to confirm this theory such as imaging and detailed examination of the contralateral rotator shoulder.

In contrast, the predictors of lower shoulder functional scores at 2 years were ipsilateral or contralateral prior surgery, smoking, partial repairs, worse preoperative pain and atrophy in the infraspinatus. These factors make sense, and many have been identified in previous studies of rotator cuff repair outcomes. Finally, the authors performed postoperative MRI at 1 year on 444 patients and found that 80% of tears healed. It could be interesting to evaluate how tendon healing relates to functional outcome in their cohort.

In sum, this is a well-done paper that encourages the treating physician to pay close attention to both shoulders during the preoperative evaluation, and especially in cases of significant atrophy, revision surgeries and patients who smoke, be sure to counsel patients appropriately regarding postoperative expectations.