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.

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.

Arthroscopic Subscapularis Tendon Repair Using the Mason-Allen Technique

2021 ◽  
Author(s):  
Junqi Huang ◽  
Jiajia Cheng ◽  
Shitian Tang ◽  
Bo Shi ◽  
Gang Liu ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Tendon Repair ◽  
Shoulder Function ◽  
Arthroscopic Rotator Cuff Repair ◽  
Subscapularis Tendon ◽  
Function Recovery ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Background Arthroscopic rotator cuff repair has recently been popularized for treating tears. In a biomechanical trial, the Mason-Allen stitch improved the fixation quality of poorly vascularized tendons. The use of this technique involving the subscapularis tendon remains rare. The aim of this study was to evaluate the clinical outcomes of Mason-Allen technique repaired subscapularis tendons. Methods A retrospective research of collected data from 98 patients with subscapularis tears who had undergone arthroscopic repair between May 2015 and December 2018. There were 75 males and 23 females. The mean age was 56.4 ± 9.6 years and the mean follow-up was 12.5 ± 4.0 months. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant-Murley score were used to analyze shoulder function. An MRI was performed to assess the integrity of the repair. Results Patients had significantly less pain and a better active range of motion compared with preoperative levels. VAS improved significantly from a preoperative mean of 3.42 to a postoperative mean of 1.91. ASES increased significantly from the preoperative mean of 43.6 to the postoperative mean of 74.5. Seven cases suffered from retears, which were confirmed by an MRI examination. Conclusion Arthroscopic rotator cuff repair with the Mason-Allen method resulted in a decreased level of pain and satisfied function recovery.

Does an Injection of Adipose-Derived Mesenchymal Stem Cells Loaded in Fibrin Glue Influence Rotator Cuff Repair Outcomes? A Clinical and Magnetic Resonance Imaging Study

2017 ◽  
Vol 45 (9) ◽  
pp. 2010-2018 ◽  
Author(s):  
Yong Sang Kim ◽  
Chang Hun Sung ◽  
Sung Hoon Chung ◽  
Sang Joon Kwak ◽  
Yong Gon Koh
Keyword(s):  
Rotator Cuff ◽  
Fibrin Glue ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Conventional Group ◽  
Injection Group ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: The mesenchymal stem cell (MSC)–based tissue engineering approach has been developed to improve the treatment of rotator cuff tears. Hypothesis/Purpose: The purpose was to determine the effect of an injection of adipose-derived MSCs loaded in fibrin glue during arthroscopic rotator cuff repair on clinical outcomes and to evaluate its effect on structural integrity using magnetic resonance imaging (MRI). The hypothesis was that the application of adipose-derived MSCs would improve outcomes after the surgical repair of a rotator cuff tear. Study Design: Cohort study; Level of evidence, 3. Methods: Among 182 patients treated with arthroscopic surgery for a rotator cuff tear, 35 patients treated with arthroscopic rotator cuff repair alone (conventional group) were matched with 35 patients who underwent arthroscopic rotator cuff repair with an injection of adipose-derived MSCs loaded in fibrin glue (injection group) based on sex, age, and lesion size. Outcomes were assessed with respect to the visual analog scale (VAS) for pain, range of motion (ROM) (including forward flexion, external rotation at the side, and internal rotation at the back), and functional measures of the Constant score and University of California, Los Angeles (UCLA) shoulder rating scale. Repaired tendon structural integrity was assessed by using MRI at a minimum of 12 months after surgery, and the mean clinical follow-up was 28.8 ± 4.2 months in the conventional group and 28.3 ± 3.8 months in the injection group. Results: The mean VAS score at rest and during motion improved significantly in both groups after surgery. However, there were no significant differences between the groups at the final follow-up ( P = .256 and .776, respectively). Compared with preoperative measurements, forward flexion and external rotation at the side significantly improved at the final follow-up in both groups (all P < .05). However, no significant improvements in internal rotation at the back were observed in either group ( P = .625 and .834 for the conventional and injection groups, respectively). There were also no significant differences between the groups at the final follow-up for any of the 3 ROM positions (all P > .05). The mean Constant score and UCLA score improved significantly in both groups after surgery, but there were no significant differences between the groups at the final follow-up ( P = .634 and .302, respectively). MRI indicated a retear rate of 28.5% in the conventional group and 14.3% in the injection group ( P < .001). Conclusion: This study revealed that an injection of adipose-derived MSCs loaded in fibrin glue during rotator cuff repair could significantly improve structural outcomes in terms of the retear rate. There were, however, no clinical differences in the 28-month period of follow-up. Although still in the early stages of application, MSC augmentation of surgical rotator cuff repair appears useful for providing an adequate biological environment around the repair site.

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 Complications of the Fingers and Hand After Arthroscopic Rotator Cuff Repair

2018 ◽  
Vol 12 (1) ◽  
pp. 134-140 ◽  
Author(s):  
Mikio Harada ◽  
Nariyuki Mura ◽  
Masatoshi Takahara ◽  
Michiaki Takagi
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Corticosteroid Injection ◽  
Pain Syndrome ◽  
Cubital Tunnel Syndrome ◽  
Arthroscopic Rotator Cuff Repair ◽  
Tunnel Syndrome ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Complications of the fingers and hand that occur after Arthroscopic Rotator Cuff Repair (ARCR) have not been examined in detail. Objective: The aim of our study was to evaluate the diagnosis and treatment of complications of the fingers and hand that occur after ARCR and to examine treatment outcomes. Methods: The case records of 40 patients (41 shoulders) who underwent ARCR using suture anchors were retrospectively reviewed to investigate complications of the fingers and hand after ARCR. Results: Twelve patients (29%) experienced numbness, pain, edema, and movement limitations of the fingers and hand. These symptoms occurred on average 1.1 months (range, 0.1-2.5 months) after ARCR. The diagnoses were cubital tunnel syndrome in 2 hands, carpal tunnel syndrome in 3 hands, and flexor tenosynovitis (TS) in 10 hands. None of the 10 hands with TS exhibited triggering of the fingers. The mean interval between treatment initiation and symptom resolution was 2.2 months for the 5 hands treated by corticosteroid injection or surgery and 5.9 months for the 7 hands treated by alternating warm and cold baths alone. None of the hands exhibited Complex Regional Pain Syndrome (CRPS). Conclusion: Complications of the fingers and hand after ARCR were observed in 29%. TS was the most frequent complication. When symptoms in the fingers and hand occur after ARCR, rather than immediately suspecting CRPS, TS should be primarily suspected, including when TS symptoms such as triggering are not present, and these patients should be treated proactively using corticosteroid injections or surgery.

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 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]

The Effect of Preexisting and Shoulder-Specific Depression and Anxiety on Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair

2019 ◽  
Vol 47 (13) ◽  
pp. 3073-3079 ◽  
Author(s):  
Brian C. Lau ◽  
Melissa Scribani ◽  
Jocelyn Wittstein
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Depression And Anxiety ◽  
Patient Reported ◽  
Outcome Scores ◽  
History Of ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
History Of Depression

Background: Few studies have considered the potential effect of depression or anxiety on outcomes after rotator cuff repair. Purpose: To evaluate the effect of a preexisting diagnosis of depression or anxiety, as well as the feeling of depression and anxiety directly related to the shoulder, on the American Shoulder and Elbow Surgeons (ASES) score. Study Design: Cohort study; Level of evidence, 3. Methods: This study is a retrospective review of prospectively collected data on patients who underwent arthroscopic rotator cuff repair and were evaluated by the ASES score preoperatively and at a minimum 12 months postoperatively as part of the senior author’s shoulder registry. Preexisting diagnoses of depression and/or anxiety were recorded, and questions from the Western Ontario Rotator Cuff Index directed at feelings of depression or anxiety related to the shoulder were also evaluated. The Wilcoxon rank sum test was used to compare ASES scores between patients with and without anxiety and/or depression. Spearman correlation was used to correlate questions on depression and anxiety with ASES scores. Results: A total of 187 patients (63 females, 124 males; mean age, 58.6 years, SD, 8.7 years) undergoing arthroscopic rotator cuff repair were evaluated with a mean follow-up of 47.5 months (SD, 17.4 months; range, 12-77 months). Fifty-three patients (mean age, 60 years; SD, 8.6 years) had preexisting diagnoses of depression and/or anxiety and 134 patients (mean age, 58.1 years; SD, 8.7 years) did not. Patients with depression and/or anxiety had significantly lower preoperative and postoperative ASES scores (60.7 vs 67.8, P = .014; and 74.6 vs 87.1, P = .008, respectively). The change in ASES scores from preoperative to postoperative, however, was not significantly different (18.0 vs 14.9). A higher score of depression or anxiety related to the shoulder had a negative correlation with the preoperative ( r = −0.76, P < .0001; and r = −0.732, P < .0001, respectively) and postoperative ( r = −0.31, P = .0001; and r = −0.31, P = .0003, respectively) ASES scores, but a positive correlation ( r = 0.50, P < .0001; and r = 0.43, P < .0001, respectively) with the change in ASES scores. Conclusion: Patients with a history of depression and/or anxiety have lower outcome scores preoperatively and postoperatively; however, they should expect the same amount of relief from arthroscopic rotator cuff repair as those without a history of depression or anxiety. Stronger feelings of depression or anxiety directly related to the shoulder correlated with lower preoperative and postoperative outcome scores, but a greater amount of improvement from surgery. The results from this study suggest that a preexisting diagnosis of depression or anxiety, as well as feelings of depression or anxiety directly related to the shoulder, should be considered during the management of patients with rotator cuff tears.

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