Establishing Maximal Medical Improvement After Arthroscopic Rotator Cuff Repair

2017 ◽  
Vol 46 (4) ◽  
pp. 1000-1007 ◽  
Author(s):  
William A. Zuke ◽  
Timothy S. Leroux ◽  
Bonnie P. Gregory ◽  
Austin Black ◽  
Brian Forsythe ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Arthroscopic Rotator Cuff Repair ◽  
Orthopaedic Care ◽  
Patient Reported ◽  
Clinically Significant ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. Purpose: Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care. Given that arthroscopic rotator cuff repair is a common ambulatory orthopaedic procedure, the purpose of this study was to establish a time frame for maximal medical improvement (the state when improvement has stabilized) after arthroscopic rotator cuff repair. Study Design: Systematic review. Methods: A systematic review of the literature was conducted, identifying studies reporting sequential patient-reported outcomes up to a minimum of 2 years after arthroscopic rotator cuff repair. The primary clinical outcome was patient-reported outcomes at 3-month, 6-month, 1-year, and 2-year follow-up. Secondary clinical outcomes included range of motion, strength, retears, and complications. Clinically significant improvement was determined between various time intervals by use of the minimal clinically important difference. Results: The review included 19 studies including 1370 patients who underwent rotator cuff repair. Clinically significant improvement in patient-reported outcomes was seen up to 1 year after rotator cuff repair, but no clinical significance was noted from 1 year to 2 years. The majority of improvement in strength and range of motion was seen up to 6 months, but no clinically meaningful improvement was seen thereafter. All reported complications and the majority of retears occurred within 6 months after rotator cuff repair. Conclusion: After rotator cuff repair, a clinically significant improvement in patient-reported outcomes, range of motion, and strength was seen up to 1 year after surgery, but not beyond this. This information is important not only to establish appropriate patient expectations but also to determine a time frame for outcome collection after surgery to better define value in orthopaedic care.

scholarly journals Randomized Prospective Trial of Arthroscopic Rotator Cuff With or Without Acromioplasty: No Difference in Patient-reported Outcomes at Long-term Follow-up

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008 ◽  
Author(s):  
Brian Robert Waterman ◽  
Jonathan Newgren ◽  
Anirudh K. Gowd ◽  
Brandon C. Cabarcas ◽  
Bernard R. Bach ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Arthroscopic Rotator Cuff Repair ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Objectives: To evaluate long-term clinical outcomes after arthroscopic rotator cuff repair with and without acromioplasty. Methods: Between 2007-2011, prospectively-enrolled patients undergoing arthroscopic repair for full-thickness rotator cuff tears were previously randomized into either acromioplasty or non-acromioplasty groups. Patients with death, advanced neurologic conditions, or subsequent shoulder arthroplasty were excluded. Baseline and long-term follow-up questionnaires, including the American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), University of California-Los Angeles (UCLA), Visual Analog Scale (VAS) for pain, and Constant scores were obtained. Rates of revision rotator cuff surgery, or secondary reoperation were recorded. Averages with standard deviation (SD) were calculated, and t-tests were utilized to compare outcomes of interest between cohorts. Results: After exclusion of 5 additional patients from the short-term follow-up study, 66 of 90 patients (73.3%) were available at 92.4 months (±10.5). Comparison of baseline demographics and intraoperative information revealed no significant differences, including age, gender, workers compensation, acute mechanism of injury, tear size, degree of retraction, and surgical technique (e.g. single- vs. double-row). At final follow-up, there were no statistically significant differences according to ASES (p=0.33), VAS pain (p=0.79), Constant (p=0.17), SST (p=0.05), UCLA (p=0.19), and SF-12 (p=0.79) in patients with and without acromioplasty (Figure 1). One patient with acromioplasty (2.9%) and two patients without acromioplasty (6.3%) sustained atraumatic recurrent rotator cuff tear with secondary repair (p=0.99). Conclusion: Combined acromioplasty and rotator cuff repair offer no significant long-term benefits in patient-reported outcomes or secondary surgery when compared to arthroscopic rotator cuff repair alone. [Figure: see text]

scholarly journals Sex-Based Differences in Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988195
Author(s):  
Stephen D. Daniels ◽  
Cory M. Stewart ◽  
Kirsten D. Garvey ◽  
Emily M. Brook ◽  
Laurence D. Higgins ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Surgical Techniques ◽  
Arthroscopic Rotator Cuff Repair ◽  
Patient Reported ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Rotator cuff repair is one of the most common surgical procedures performed on the shoulder. Previous studies have indicated that pain and disability can vary significantly between patients with similarly appearing rotator cuff tears on diagnostic imaging. Prior literature has compared functional outcomes between operative and nonoperative treatments as well as variability in surgical techniques. However, few studies have examined postoperative outcomes based on patient factors such as sex. Purpose: To compare patient-reported outcomes after rotator cuff repair between men and women. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 283 patients (153 male, 130 female) who underwent primary arthroscopic rotator cuff repair were included in this study; of those, 275 patients (97.2%) completed 1-year follow-up. Patient-reported pain visual analog scale (VAS), Veterans RAND 12-item Health Survey (VR-12 mental and physical components), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores were collected preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively using an electronic outcomes system. Results: Women reported higher VAS pain scores when compared with men preoperatively ( P < .01) and at 2 weeks ( P < .01), 6 weeks ( P < .01), and 3 months ( P = .02) postoperatively. Additionally, women experienced a greater overall change in the mean VAS score preoperatively when compared with 1 year postoperatively ( P < .01). The use of narcotic pain medication 2 weeks after surgery was greater in women ( P = .032). Women had significantly lower preoperative VR-12 mental scores ( P = .03) and experienced a greater increase in the mean VR-12 mental score preoperatively when compared with 1 year postoperatively ( P < .01). Men had higher ASES scores preoperatively ( P < .01) and at 3 months postoperatively ( P < .01). Women experienced a greater overall change in the ASES score preoperatively when compared with 1 year postoperatively ( P < .01). Conclusion: Women reported greater pain and decreased shoulder function compared with men during the initial 3 months after arthroscopic rotator cuff repair. There were no sex-based differences in patient-reported outcomes at 1-year follow-up. The results of this study indicate that there are sex-related differences in the early postoperative recovery of patients undergoing rotator cuff repair, contributing to postoperative expectations for both clinicians and patients alike.

scholarly journals Recall Bias in Retrospective Assessment of Preoperative Patient Reported Outcomes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0033
Author(s):  
Matthew J. Gotlin ◽  
Samuel Baron ◽  
Matthew T. Kingery ◽  
Joseph McCafferty ◽  
Medical Student ◽  
...  
Keyword(s):  
Health Status ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Arthroscopic Rotator Cuff Repair ◽  
Orthopedic Procedures ◽  
Recall Bias ◽  
Patient Reported ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Objectives: Patient reported outcomes (PROs) are measures of function, disability, and health status that may offer a unique assessment of provider quality and performance. The gold-standard method for collecting PROs is the prospective assessment of preoperative to postoperative change. This requires data collection before an intervention and then again after the intervention. This method is not always feasible due to unforeseen cases or emergencies, logistical and infrastructure barriers, and cost issues. In such cases a retrospective approach serves as a potential alternative. In this model, a patient is asked to complete an assessment about their perceived preoperative status during a time period sometime after the surgery. Although this method has its advantages, there is a particular risk of recall bias. There are conflicting conclusions regarding the reliability of the recalled preoperative PROs after orthopedic procedures. The aim of our study was to assess the agreement between prospectively and retrospectively collected PROs for a common, low-risk procedure. Methods: Patients that underwent arthroscopic rotator cuff repair between May 2012 and September 2017 at the study institution were identified. Inclusion criteria consisted of primary arthroscopic rotator cuff repair and preoperative prospectively collected American Shoulder and Elbow Surgeons Standard Shoulder Assessment Form (ASES) scores. All of the patients completed the ASES form preoperatively at their pre-assessment appointment. Patients were then contacted in the postoperative period and asked to recall their preoperative condition while completing another ASES form. Results: Seventy-one patients were included in this analysis (mean age 56.18 ± 10.48 years). The mean duration of symptoms from initial onset to the time of surgery was 8.54 ± 9.28 months. There was an average of 37.53 ± 17.02 months between the preoperative ASES and the recall ASES. Recall ASES scores were significantly lower than preoperative ASES scores (31.65 ± 16.87 vs 50.92 ± 19.57, p < 0.001). Less severe preoperative shoulder dysfunction was predictive of a greater difference between preoperative ASES and recall ASES (β = -0.60, R2 = 0.350, p < 0.001) (see Figure). Each 10-point increase in preoperative ASES score was predictive of a 6.04 point greater mismatch between preoperative and recall ASES. Likewise, a longer symptomatic period prior to surgery was associated with a greater ASES mismatch (R2 = 0.063, p = 0.029). The duration of time between surgery and recall was not a significant predictor of a difference between preoperative and recall ASES. Conclusion: This study demonstrated that there is poor agreement between prospectively and retrospectively collected preoperative PROs in the setting of rotator cuff surgery. Patient’s recalled ASES scores were significantly lower than their prospectively recorded ASES scores. This could lead to an overestimation of perceived benefit or effectiveness of the intervention. Our data supports prior studies that demonstrated that retrospective PROs are subject to recall bias and have been found to produce more favorable results than prospectively monitored health status data from the same patient. Our study supports the use of prospectively collected PROs and retrospective PROs should only be used in situations where baseline assessments are not possible.

Recall Bias in Retrospective Assessment of Preoperative Patient-Reported American Shoulder and Elbow Surgeons Scores in Arthroscopic Rotator Cuff Repair Surgery

2020 ◽  
Vol 48 (6) ◽  
pp. 1471-1475
Author(s):  
Matthew J. Gotlin ◽  
Matthew T. Kingery ◽  
Samuel L. Baron ◽  
Joseph McCafferty ◽  
Laith M. Jazrawi ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Recall Bias ◽  
Duration Of Symptoms ◽  
Shoulder Dysfunction ◽  
Patient Reported ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: The gold-standard method for collecting patient-reported outcomes (PROs) is the prospective assessment of preoperative to postoperative change. However, this method is not always feasible because of unforeseen cases or emergencies, logistical and infrastructure barriers, and cost issues. In such cases, a retrospective approach serves as a potential alternative, but there are conflicting conclusions regarding the reliability of the recalled preoperative PROs after orthopaedic procedures. Purpose: To assess the agreement between prospectively and retrospectively collected PROs for a common, low-risk procedure. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Patients who underwent arthroscopic rotator cuff repair between May 2012 and September 2017 at the study institution were identified. All of the patients completed the American Shoulder and Elbow Surgeons (ASES) Standard Shoulder Assessment Form preoperatively at their preassessment appointment. Patients were then contacted in the postoperative period and asked to recall their preoperative condition while completing another ASES form. Results: A total of 84 patients completed the telephone survey and were included in this analysis (mean age, 57.40 ± 9.96 years). The mean duration of time from onset of shoulder symptoms to surgery was 9.13 ± 9.08 months. The mean duration of time between surgery and recall ASES administration was 39.12 ± 17.37 months. The mean recall ASES score was significantly lower than the preoperative ASES score (30.69 ± 16.93 vs 51.42 ± 19.14; P < .001). There was poor test-retest reliability between preoperative ASES and recall ASES (intraclass correlation coefficient, 0.292; 95% CI, –0.07, 0.57; P = .068). Greater age at the time of recall, a shorter symptomatic period before surgery, and less severe preoperative shoulder dysfunction were associated with a greater difference between preoperative ASES and recall ASES. Conclusion: Retrospectively reported PROs are subject to significant recall bias. Recalled PROs were almost always lower than their prospectively recorded counterparts. Recalled PROs are more likely to be accurate when reported by younger patients, those with a longer duration of symptoms, and those with more severe preoperative conditions.

Early Versus Delayed Passive Range of Motion Exercise for Arthroscopic Rotator Cuff Repair

2014 ◽  
Vol 43 (5) ◽  
pp. 1265-1273 ◽  
Author(s):  
Ke-Vin Chang ◽  
Chen-Yu Hung ◽  
Der-Sheng Han ◽  
Wen-Shiang Chen ◽  
Tyng-Guey Wang ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Motion Exercise ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

scholarly journals Early and Delayed Postoperative Rehabilitation after Arthroscopic Rotator Cuff Repair: A Comparative Study of Clinical Outcomes

2019 ◽  
Vol 22 (4) ◽  
pp. 190-194
Author(s):  
Sungwook Choi ◽  
Kyu Bum Seo ◽  
Seungjae Shim ◽  
Ju Yeon Shin ◽  
Hyunseong Kang
Keyword(s):  
Rotator Cuff ◽  
Visual Analogue Scale ◽  
Range Of Motion ◽  
Rotator Cuff Repair ◽  
Analogue Scale ◽  
Constant Score ◽  
Arthroscopic Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Shoulder Score

Background: The duration of immobilization after arthroscopic rotator cuff repair and the optimal time to commence rehabilitation are still the subject of ongoing debates. This study was undertaken to evaluate the functional outcome and rotator cuff healing status after arthroscopic rotator cuff repair by comparing early and delayed rehabilitation.Methods: Totally, 76 patients with small, medium, and large sized rotator cuff tears underwent arthroscopic repair using the suture-bridge technique. In early rehabilitation group, 38 patients commenced passive range of motion at postoperative day 2 whereas 38 patients assigned to the delayed rehabilitation group commenced passive range of motion at postoperative week 3. At the end of the study period, clinical and functional evaluations (Constant score, the University of California, Los Angeles [UCLA] shoulder score) were carried out, subsequent to measuring the range of motion, visual analogue scale for pain, and isokinetic dynamometer test. Rotator cuff healing was confirmed by magnetic resonance imaging at least 6 months after surgery.Results: No significant difference was obtained in range of motion and visual analogue scale between both groups. Functional outcomes showed similar improvements in the Constant score (early: 67.0?88.0; delayed: 66.9?91.0; <i>p</i><0.001) and the UCLA shoulder score (early: 20.3?32.3; delayed: 20.4?32.4; <i>p</i><0.001). Furthermore, rotator cuff healing showed no significant differences between the groups (range, 6?15 months; average, 10.4 months).Conclusions: Delayed passive rehabilitation does not bring about superior outcomes. Therefore, early rehabilitation would be useful to help patients resume their daily lives.

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