Monday, January 7, 2013

Rotator cuff repair - workers' compensation

Prospective evaluation of postoperative compliance and outcomes after rotator cuff repair in patients with and without workers' compensation claims.

This study prospectively evaluated compliance and outcomes after rotator cuff repair in 42 consecutive patients with Workers' Compensation claims and 50 consecutive patients without a Workers' Compensation claim who underwent arthroscopic rotator cuff repair (transosseous equivalent suture bridge or margin convergence). There were important differences between the WC and non WC groups with respect to female gender (19% vs 38%), smoking (60% vs 24%) and age (51 vs 63 years). Tear size was similar for the two groups: 32% small, 39% medium, 25% large, and 4% massive.

Post operative rehab prescribed included sling + pendulum X 6 weeks. Compliance was documented in terms of sling wear and attendance at post operative PT appointments. Noncompliance with protocol was documented in 52% in the Work Comp group compared with 4% in the non-Work Comp group (P < .001). The Work Comp group had less improvement in preoperative to postoperative outcome scores for the Simple Shoulder Test (SST) score (3.9 to 6.0) compared with the non-Work Comp group 4.3 to 10.7.  The compliant Work Comp patients had more favorable results in final SST, 7.9  than noncompliant Work Comp patients SST.

Postoperative ultrasounds showed 84% of the non Work Comp group had intact cuffs in comparison to 75% of the compliant Work Comp and 59% of the non compliant Work Comp group.

The authors did not perform a multivariate analysis to explore the relationship between age, smoking, tear size, tendon retraction, repair method, compliance, Work Comp status, and gender with retears or the relationship between age, smoking, tear size, tendon retraction, repair method, compliance, Work Comp status, gender, and post operative cuff integrity with the functional outcome. Such analyses would be helpful in determining the most important predictors of the results of cuff repair surgery.

Some other studies of 'what matters' in cuff repair are highlighted here.



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