The Influence of Rotator Cuff Tear Size and Repair Technique on Creation and Management of Dog Ear Deformities in a Transosseous Equivalent Rotator Cuff Repair Model

Background: Rotator cuff repair often results in significant pain postoperatively, the cause of which is undetermined. Purpose/Hypothesis: The aim of this study was to evaluate the relationship between rotator cuff tear area and postoperative pain in patients who had undergone arthroscopic rotator cuff repair. We hypothesized that larger tears would be more painful because of elevated repair tension at 1 week postoperatively but that smaller tears would be more painful because of a greater healing response, especially from 6 weeks postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 1624 patients who underwent arthroscopic rotator cuff repair were included in this study. Exclusion criteria were moderate to severe osteoarthritis, isolated subscapularis repair, calcific tendinitis, synthetic patch repair, revision surgery, and retears on ultrasound at 6 months after surgery. Rotator cuff tears were subdivided into groups based on the tear size and retear rate found for each group. A modified L’Insalata questionnaire was given before surgery and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Pearson and Spearman correlation coefficient tests were performed between rotator cuff tear areas and pain scores. Results: Intraoperative rotator cuff tear areas did not correlate with pain scores preoperatively or at 1 week after surgery. A smaller tear area was associated with more frequent and severe pain with overhead activities, at rest, and during sleep as well as a poorer perceived overall shoulder condition at 6 weeks, 3 months, and 6 months after repair ( r = 0.11-0.23, P < .0001). Patients who were younger, had partial-thickness tears, and had occupational injuries experienced more pain postoperatively ( r = 0.10-0.28, P < .0001). Larger tears did not have more pain at 1 week after surgery. The retear rate was 7% in tears <2 cm2 but reached 44% in tears >8 cm2. Conclusion: There were fewer retears with smaller tears, but they were more painful than large tears postoperatively from 6 weeks to 6 months after surgery. Smaller tears may heal more vigorously, causing more pain. Patients with smaller tears experienced more pain after rotator cuff repair compared with patients with larger tears. These findings are contrary to previous ideas about tear size and postoperative pain. Healing is likely a determinant of postoperative pain.

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Prevalence and Risk Factors of Neuropathic Pain in Patients with a Rotator Cuff Tear

January 2018 - Pain Physician ◽

10.36076/ppj.2018.2.e173 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E173-E180 ◽

Cited By ~ 4

Author(s):

Sangbong Ko

Keyword(s):

Neuropathic Pain ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Full Thickness ◽

Cuff Tear ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair ◽

Tear Size

Background: Until now, few studies had investigated the neuropathic pain component in patients with a rotator cuff tear (RCT). Objectives: The aim of the study was to identify the neuropathic pain component in patients with RCT and to determine the factors correlated with neuropathic pain in patients with RCT. Study Design: Prospective, cohort, prognostic study. Setting: Study patients who required arthroscopic rotator cuff repair were analyzed in a hospital setting. Methods: We prospectively studied 101 patients who were less than 60 years old with fullthickness tears requiring arthroscopic rotator cuff repair and met the inclusion and exclusion criteria. Multiple regression analysis was performed to identify variables that independently affected neuropathic pain in patients with a RCT. We use Douleur neuropathique 4 questionnaire (DN4) to assess neuropathic pain, which was ≥ 4 points of the DN4 questionaire. The visual analog scale (VAS) for the most severe pain within 4 weeks before admission and mean pain level during the last 4 weeks were checked. The atrophy grades of the rotator cuff muscles were classified on magnetic resonance images according to the Goutallier classification. The size and medial retraction of the RCT were measured during arthroscopic repair for RCT. Results: Sixteen (15.8%) of the 101 patients had neuropathic pain according to the cutoff values on the DN4 questionnaire for diagnosing neuropathic pain. The neuropathic pain group had significantly higher prevalence of smoking (P = 0.042), more mean VAS during last 4 weeks (P = 0.008), larger cuff tear (P = 0.003), more medial retraction of cuff (P = 0.016), and severe fatty degeneration of rotator cuff muscles (supraspinatus, P < 0.001; subscapularis, P < 0.001; and infraspinatus, P = 0.003) than the nonneuropathic pain group. The multiple logistic regression analyses showed that more mean VAS during the last 4 weeks and tear size of a rotator cuff were independent of other factors for the neuropathic pain of the patients with a full-thickness RCT. Limitations: Small sample size is the first limitation of this study. Conclusions: The prevalence of neuropathic pain in patients with a full-thickness RCT requiring arthroscopic rotator cuff repair was 15.8 % according to the DN4 questionnaire. The neuropathic pain component was more relevant to the severity of pain and tear size in the patients with a full-thickness RCT. It is important to be aware of the existence of neuropathic pain when treating a patient presenting with pain due to a RCT because accompanying neuropathy with a RCT could have a worse effect on repair of a RCT. IRB approval and clinical trial registration number: CR-15-045 Key words: Shoulder, rotator cuff tear, arthroscopic rotator cuff repair, neuropathic pain

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