Sunday, January 27, 2013

Rotator cuff repair outcomes

Long-Term Longitudinal Follow-up of Mini-Open Rotator Cuff Repair

This is an average 16 yr followup of 49 of 79 who had mini-open rotator cuff repair from 1993 to 1996. Outcomes were reviewed in 1997, 2002, and 2010. Eight were large tears, forty medium tears, and one small tear. 34 had good or excellent results and 41 were were satisfied with the final outcome of the procedure. Interestingly patient satisfaction at the final evaluation did not necessarily correspond with a good or an excellent UCLA score.

This study demonstrates the challenges of a long term followup study, specifically the patients lost to followup (20%) and the 18% percent that were lost because of death or dementia.

The authors did not determine the integrity of the repairs in those shoulders with good and poor results. They state that "there are studies that demonstrate that the functional outcome following shoulder surgery is not determined by the integrity of the cuff". Does this mean we shouldn't care about integrity?

The lack of this information makes it difficult to know how much surgical and rehabilitative effort should be put into achieving cuff integrity in the treatment of rotator cuff tears. What matters?

We are interested in finding out the predictors of achieving integrity in managing cuff tears so we can learn when to repair and when to smooth and move. In other words, if the functional outcome is indeed unrelated to integrity, why do the repair at all?

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