The relationship of preoperative factors to patient-reported outcome in rotator cuff repair: a systematic review

2016 ◽  
Vol 21 (3-6) ◽  
pp. 138-150 ◽  
Author(s):  
Jason D. Woollard ◽  
James E. Bost ◽  
Sara R. Piva ◽  
G. Kelley Fitzgerald ◽  
Mark W. Rodosky ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Relationship Of ◽  
The Relationship ◽  
Cuff Repair ◽  
Preoperative Factors

The Responsiveness of Patient- Reported Outcome Tools in Shoulder Surgery Is Dependent on the Underlying Pathological Condition

2018 ◽  
Vol 47 (1) ◽  
pp. 241-247 ◽  
Author(s):  
R. Zackary Unger ◽  
Jeremy M. Burnham ◽  
Lee Gammon ◽  
Chaitu S. Malempati ◽  
Cale A. Jacobs ◽  
...  
Keyword(s):  
Systematic Review ◽  
Los Angeles ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Pathological Condition ◽  
Patient Reported Outcome ◽  
Shoulder Surgery ◽  
Patient Reported ◽  
Pro Tools ◽  
Cuff Repair

Background: Given the high number of available patient-reported outcome (PRO) tools for patients undergoing shoulder surgery, comparative information is necessary to determine the most relevant forms to incorporate into clinical practice. Purpose: To determine the utilization and responsiveness of common PRO tools in studies involving patients undergoing arthroscopic rotator cuff repair or operative management of glenohumeral instability. Study Design: Systematic review. Methods: A systematic review of rotator cuff and instability studies from multiple databases was performed according to PRISMA guidelines. Means and SDs of each PRO tool utilized, study sample sizes, and follow-up durations were collected. The responsiveness of each PRO tool compared with other PRO tools was determined by calculating the effect size and relative efficiency (RE). Results: After a full-text review of 238 rotator cuff articles and 110 instability articles, 81 studies and 29 studies met the criteria for final inclusion, respectively. In the rotator cuff studies, 25 different PRO tools were utilized. The most commonly utilized PRO tools were the Constant (50 studies), visual analog scale (VAS) for pain (44 studies), American Shoulder and Elbow Surgeons (ASES; 39 studies), University of California, Los Angeles (UCLA; 20 studies), and Disabilities of the Arm, Shoulder and Hand (DASH; 13 studies) scores. The ASES score was found to be more responsive than all scores including the Constant (RE, 1.94), VAS for pain (RE, 1.54), UCLA (RE, 1.46), and DASH (RE, 1.35) scores. In the instability studies, 16 different PRO tools were utilized. The most commonly used PRO tools were the ASES (13 studies), Rowe (10 studies), Western Ontario Shoulder Instability Index (WOSI; 8 studies), VAS for pain (7 studies), UCLA (7 studies), and Constant (6 studies) scores. The Rowe score was much more responsive than both the ASES (RE, 22.84) and the Constant (RE, 33.17) scores; however, the ASES score remained more responsive than the Constant (RE, 1.93), VAS for pain (RE, 1.75), and WOSI (RE, 0.97) scores. Conclusion: Despite being frequently used in the research community, the Constant score may be less clinically useful as it was less responsive. Additionally, it is a greater burden on the provider because it requires objective strength and range of motion data to be gathered by the clinician. In contrast, the ASES score was highly responsive after rotator cuff repair and requires only subjective patient input. Furthermore, separate PRO scoring methods appear to be necessary for patients undergoing rotator cuff repair and surgery for instability as the instability-specific Rowe score was much more responsive than the ASES score.

Radiographic shoulder parameters and their relationship to outcomes following rotator cuff repair: a systematic review

2020 ◽  
pp. 175857321989598
Author(s):  
Musa B Zaid ◽  
Nathan M Young ◽  
Valentina Pedoia ◽  
Brian T Feeley ◽  
C Benjamin Ma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Critical Shoulder Angle ◽  
Patient Reported ◽  
Acromion Index ◽  
Bony Morphology ◽  
Cuff Repair ◽  
Shoulder Angle

Background Anatomic parameters, such as the critical shoulder angle and acromion index, have emerged as methods to quantify scapular anatomy and may contribute to rotator cuff pathology. The purpose of this paper is to investigate the published literature on influences of scapular morphology on the development of re-tears and patient-reported outcomes following rotator cuff repair. Methods A systematic review of the Embase and PubMed databases was performed to identify published studies on the potential influence of scapular bony morphology and re-tear rates and patient-reported outcomes after rotator cuff repair. Studies were reviewed by two authors. Results A total of 615 unique titles and 49 potentially relevant abstracts were reviewed, with eight published manuscripts identified for inclusion. Two of three papers reported no relationship between these acromion index and rotator cuff re-tear rate, while one paper found an increased re-tear rate. All three studies on critical shoulder angle found a significant association between critical shoulder angle and cuff re-tear rate. There was no clear relationship between any bony morphologic measurement and patient-reported outcomes after rotator cuff repair. Conclusions Rotator cuff re-tear rate appears to be significantly associated with the critical shoulder angle and glenoid inclination, while not clearly associated with acromial morphologic measurements.

scholarly journals Preoperative Psychometric Properties of PROMIS Upper Extremity, Pain Interference, and Depression in Bankart Repair and Rotator Cuff Repair (115)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0026
Author(s):  
Amar Vadhera ◽  
Alexander Beletsky ◽  
Harsh Singh ◽  
Jorge Chahla ◽  
Brian Cole ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Upper Extremity ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcome ◽  
Bankart Repair ◽  
Orthopedic Procedures ◽  
Patient Reported ◽  
Ceiling Effects ◽  
Cuff Repair ◽  
Score Distributions

Objectives: To examine the preoperative and postoperative performance of PROMIS Upper Extremity 2.0 across various orthopedic procedures for the upper extremity. Secondarily, to define susceptibility to pre- and post-operative floor and ceiling effects. Methods: Retrospective analysis of prospectively collected patient-reported outcome (PRO) data was conducted utilizing an electronic outcome registry for procedures between May 2017 and August 2018. Current procedural terminology (CPT) codes were utilized to examine cohorts for various upper extremity orthopedic procedures including Bankart repair and arthroscopic rotator cuff repair (ARCR). Shapiro-Wilks normality testing was used to assess score distributions for normalcy; given non-normal score distributions, Spearman correlation coefficients were calculated for preoperative patient-reported outcome (PRO) scores. Absolute floor and ceiling effects were calculated for each time point based on CPT code. Results: A total of 488 patients were included across Bankart repair (n=109, 29.3 + 12.5 years) and ARCR (n=379, 57.5 + 9.5 years) cohorts. In the Bankart repair cohort, PROMIS PI demonstrate strong correlations with ASES (r=-0.63), Constant (r=-0.75), PROMIS UE (r=-0.75), and the VR6D (r=-0.61). PROMIS Depression (r=0.23 vs. 0.17), SF12 MCS (r=0.34 vs. 0.11), and VR12 MCS (r=0.44 vs. 0.15) exhibited poor correlations with PROMIS PI and UE, respectively. In the ARCR cohort, PROMIS PI scores demonstrated a good correlation with PROMIS UE (r=0.61). Constant (r=0.58 vs. 0.67), VR12 PCS (r=0.58 vs. 0.47), and VR6D (r=0.67 vs. 0.53) exhibited good correlations with both PROMIS PI and UE measures, respectively. No significant absolute floor or ceiling effects were observed for the PROMIS instruments except PROMIS Depression; an absolute floor was noted for both Bankart (n=12, 30%) and ARCR (n=38, 14.7%) groups. Conclusions: PROMIS PI and UE instruments perform comparably to legacy outcome instruments in patients receiving Bankart repair, as well as those receiving ARCR. Furthermore, in both populations, the PROMIS Depression instrument exhibits absolute floor effects, whereas PROMIS PI and UE instruments fail to demonstrate any absolute floor or ceiling effects.

Effect of Acromioplasty on Postoperative Pain Following Rotator Cuff Repair

2021 ◽  
pp. 155633162199312
Author(s):  
Chintanpreet Singh ◽  
Patrick H. Lam ◽  
George A. C. Murrell
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcome ◽  
Additional Benefit ◽  
Rotator Cuff Tears ◽  
Shoulder Stiffness ◽  
Patient Reported ◽  
Shoulder Strength ◽  
Pain At Rest ◽  
Cuff Repair

Background: The surgical treatment of rotator cuff tears traditionally involves rotator cuff repair (RCR) with concomitant acromioplasty. However, there is some doubt as to whether acromioplasty is of value to this procedure. Questions/Purpose: We sought to evaluate whether RCR with acromioplasty provided better outcomes than RCR without acromioplasty in a cohort of more than 1000 patients. Methods: This retrospective cohort study involved 1320 patients with rotator cuff tears who subsequently received a primary arthroscopic RCR, with acromioplasty (n = 160) or without acromioplasty (n = 1160), performed by a single surgeon. Acromioplasty was performed if there was significant mechanical impingement on the rotator cuff. To assess outcomes, all patients completed a standardized, modified L’Insalata questionnaire in which they reported the level and severity of pain at rest and during activities. An examiner assessed shoulder strength and range of motion before and 1 week, 6 weeks, 12 weeks, and 6 months after surgery. Results: Patients who had RCR with concurrent acromioplasty had a greater level of pain and more frequent pain 1 week after surgery. However, at 6 months there were no differences between patients who underwent RCR with or without acromioplasty in any patient-reported outcome (level of pain with overhead activity, at rest and during sleep; frequency of pain with activity, sleep and extreme pain, difficulty of activity overhead and behind back, level of shoulder stiffness; and overall shoulder satisfaction). The postoperative re-tear rate in both groups was 13%. Conclusion: This study showed no additional benefit to acromioplasty in patients undergoing RCR.

scholarly journals Time Required to Achieve Clinically Significant Outcomes After Arthroscopic Rotator Cuff Repair

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0044
Author(s):  
Brandon J. Manderle ◽  
Anirudh K. Gowd ◽  
Joseph Liu ◽  
Alexander Beletsky ◽  
Charles A. Bush-Joseph ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcome ◽  
Arthroscopic Rotator Cuff Repair ◽  
Receiver Operating Curve ◽  
Symptom Duration ◽  
Minimally Clinically Important Difference ◽  
Patient Reported ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Objectives: To define the time-dependent nature of the minimally clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) after arthroscopic rotator cuff repair (RCR). Methods: A prospectively maintained institutional registry was queried for all patients undergoing arthroscopic RCR from 2014-2017 with completed pre-operative, 6 month, 1 and 2 year patient-reported outcome measure (PROM) surveys. MCID, SCB and PASS were calculated for the American Shoulder and Elbow Surgeons Score (ASES) using anchor-based methodology with receiver operating curve/area under curve analysis. Time to MCID, SCB and PASS was calculated using Kaplan-Meier analysis. A Cox multivariate regression model was used to calculate hazard ratios with respect to preoperative factors and intraoperative pathology. Results: 95 patients were included. Average age was 56.9 ± 9.5 years, average BMI was 30.8 ± 7.0 kg/m2. Mean symptom duration was 8.5 ± 7.8 months. Established MCID, SCB, PASS for the ASES were 11.1, 17.5, and 86.7 respectively. A total of 94.8% achieved MCID, 84.4% achieved SCB, and 54.6% achieved thresholds for PASS. Median achievement of MCID, SCB, and PASS occurred at 161, 166, and 347 days, respectively. Older patients had an increased likelihood of achieving MCID and SCB (HR: 1.036, 95% CI: 1.009, 1.064, p=0.009 and HR: 1.026, 95% CI: 1.000, 1.051, p=0.045, respectively). Lower preoperative score increased the likelihood of achieving SCB (HR: 0.976, 95% CI: 0.964, 0.989, p<0.001). Sustaining a dominant sided injury reduced the likelihood of achieving PASS (HR: 0.692, 95% CI: 0.513, 0.932, p=0.015). Conclusion: This study established the timeline to reach MCID, SCB and PASS in patients undergoing primary arthroscopic RCR. 80% of patients can expect to achieve MCID and SCB within one year, while 50% achieve PASS at this time point. Future studies should account for this trend in improvement when determining appropriate follow-up. [Figure: see text][Table: see text]

Changes From Baseline in Patient- Reported Outcomes at 1 Year Versus 2 Years After Rotator Cuff Repair: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652110239
Author(s):  
Sambit Sahoo ◽  
Martina Stojanovska ◽  
Peter B. Imrey ◽  
Yuxuan Jin ◽  
Richard J. Bowles ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Cohort Studies ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Meta Analysis ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean ◽  
Cuff Repair

Background: Most orthopaedic journals currently require reporting outcomes of surgical interventions for at least 2 postoperative years, but there have been no rigorous studies on this matter. Various patient-reported outcome (PRO) measures (PROMs) have been used to assess the status of the shoulder after rotator cuff repair (RCR). Hypothesis: We hypothesized that the mean shoulder-specific PROMs at 1 year improve substantially over baseline but that there is no clinically meaningful difference between the mean 1- and 2-year PROMs after RCR. Study Design: Meta-analysis; Level of evidence, 2. Methods: We conducted a systematic review of published randomized controlled trials (RCTs) and prospective cohort studies (level of evidence 1 and 2) reporting the shoulder-specific American Shoulder and Elbow Surgeons (ASES), the Constant, or the Western Ontario Rotator Cuff (WORC) Index scores at baseline, 1 year, and 2 years after RCR. The methodologic quality of studies was assessed. Also, the random effects meta-analyses of changes in PROMs for each of the first and second postoperative years were conducted. Results: Fifteen studies (n = 11 RCTs; n = 4 cohort studies) with a total of 1371 patients were included. Studies were highly heterogeneous, but no visual evidence of major publication bias was observed. The weighted means of the baseline PROMs were 46.2 points for the ASES score, 46.4 points for the Constant score, and 38.8 points for the WORC Index. The first-year summary increments were 41.1 (95% CI, 36.0-46.2) points for the ASES score, 34.2 (95% CI, 28.8-39.6) points for the Constant score, and 42.9 (95% CI, 37.3-48.4) points for the WORC Index. In contrast, the second-year summary increments were 2.3 (95% CI, 1-3.6) points for the ASES score, 3.2 (95% CI, 1.9-4.4) points for the Constant score, and 2 (95% CI, -0.1 to 4) points for the WORC Index. Conclusion: All PROMs improved considerably from baseline to 1 year, but only very small gains that were below the minimal clinically important differences were observed between 1 year and 2 years after RCR. This study did not find any evidence for requiring a minimum of 2 years of follow-up for publication of PROs after RCR. Our results suggest that focusing on 1-year PROMs after RCR would foster more timely reporting, better control of selection bias, and better allocation of research resources.

Minimum 10-Year Outcomes of Primary Arthroscopic Transosseous-Equivalent Double-Row Rotator Cuff Repair

2021 ◽  
pp. 036354652110154
Author(s):  
Adam M. Johannsen ◽  
Justin W. Arner ◽  
Bryant P. Elrick ◽  
Philip-C. Nolte ◽  
Dylan R. Rakowski ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Revision Surgery ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Long Term Results ◽  
Double Row ◽  
Kaplan Meier ◽  
Patient Reported ◽  
Cuff Repair

Background: Modern rotator cuff repair techniques demonstrate favorable early and midterm outcomes, but long-term results have yet to be reported. Purpose: To determine 10-year outcomes and survivorship after arthroscopic double-row transosseous-equivalent (TOE) rotator cuff repair. Study Design: Case series; Level of evidence 4. Methods: The primary TOE rotator cuff repair procedure was performed using either a knotted suture bridge or knotless tape bridge technique on a series of patients with 1 to 3 tendon full-thickness rotator cuff tears involving the supraspinatus. Only patients who were 10 years postsurgery were included. Patient-reported outcomes were collected pre- and postoperatively, including American Shoulder and Elbow Surgeons (ASES), 12-Item Short Form Health Survey (SF-12), Single Assessment Numeric Evaluation (SANE), shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and satisfaction. Kaplan-Meier survivorship analysis was performed. Failure was defined as progression to revision surgery. Results: A total of 91 shoulders (56 men, 31 women) were included between October 2005 and December 2009. Mean follow-up was 11.5 years (range, 10.0-14.1 years). Of 91 shoulders, 5 (5.5%) failed and required revision surgery. Patient-reported outcomes for patients who survived were known for 80% (69/86). Outcomes scores at final follow-up were as follows: ASES, 93.1 ± 10.8; SANE, 87.5 ± 14.2; QuickDASH, 11.1 ± 13.5; and SF-12 physical component summary (PCS), 49.2 ± 10.1. There were statistically significant declines in ASES, SANE, and SF-12 PCS from the 5-year to 10-year follow-up, but none of these changes met the minimally clinically important difference threshold. Median satisfaction at final follow-up was 10 (range, 3-10). From this cohort, Kaplan-Meier survivorship demonstrated a 94.4% survival rate at a minimum of 10 years. Conclusion: Arthroscopic TOE rotator cuff repair demonstrates high patient satisfaction and low revision rates at a mean follow-up of 11.5 years. This information may be directly utilized in surgical decision making and preoperative patient counseling regarding the longevity of modern double-row rotator cuff repair.

scholarly journals Delayed Rehabilitation Protocol after Rotator Cuff Repair

Osteology ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 29-38
Author(s):  
Alessandra Berton ◽  
Sergio De Salvatore ◽  
Vincenzo Candela ◽  
Gabriele Cortina ◽  
Daniela Lo Presti ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Muscle Strength ◽  
Internal Rotation ◽  
Outcome Measures ◽  
Rotator Cuff Repair ◽  
External Rotation ◽  
Shoulder Function ◽  
Rehabilitation Protocol ◽  
Patient Reported ◽  
Cuff Repair

Rotator cuff tears are a frequent cause of shoulder pain that often require arthroscopic repair. After surgery an intense and well-studied rehabilitation protocol is needed to obtain the complete recovery of shoulder function. Fifty patients, who sustained arthroscopic rotator cuff repair for symptomatic, atraumatic and full-thickness supraspinatus tendon tear, were involved. According to our rehabilitation protocol, during the first four postoperative weeks, the arm was supported with an abduction sling pillow, and pendulum exercises, table slide and active elbow extension and flexion were conceded. Outcome measures (Oxford shoulder score (OSS), simple shoulder test (SST), patient-reported satisfaction), shoulder function (range of motion (ROM) and muscle strength), and MRI examination were evaluated. The mean OSS score and SST score increased from 16 to 30.2 and from 5.3 to 11.4, respectively. Patient-reported satisfaction was 96%. At 12 months, patients improved ROM and muscle strength. Postoperative passive anterior elevation was 176; external rotation averaged 47; internal rotation was 90. Postoperative muscle strength during anterior elevation was 8.3 ± 2.2 kg, internal rotation 6.8 ± 3 kg, external rotation 5.5 ± 2.3 kg. Five out of seven patients with recurrent tears evaluated their results as satisfactory. They reported improvements in terms of OSS and SST mean scores despite recurrent tears; therefore, they did not undergo revision surgery. The delayed postoperative physical therapy protocol was associated with improvements in the outcome measures and shoulder function compared to the preoperatory state and rotator cuff healing demonstrated by MRI.

Sign in / Sign up

Export Citation Format

Share Document