These authors performed a randomized clinical trial of 58 patients who underwent single-tendon arthroscopic rotator cuff repair of full-thickness tears performed by a single surgeon. Patients were randomized to an early- or delayed-motion protocol. At 6 months, all patients underwent magnetic resonance imaging to assess whether the rotator cuffs were intact or retorn. Quality of Life (QOL) was assessed preoperatively and at 3 weeks, 6 weeks, 12 weeks, 6 months, and 12 months postoperatively using the Western Ontario Rotator Cuff (WORC) index.
After 6 months of rehabilitation, 41 patients (71%) had intact rotator cuff repairs whereas 17 (29%) had full-thickness tears. Patients with torn rotator cuffs at 6 months postoperatively had significantly lower WORC scores at 6 weeks postoperatively (P 1⁄4 .041). Patients with greater improvements in QOL perioperatively (preoperative WORC score minus 6-week postoperative WORC score > 264.5) were more likely to have full-thickness tears by 6 months postoperatively. Compliant patients assigned to the delayed-motion protocol had a failure rate of 11% (2 of 19) compared with 38% (15 of 39) in the noncompliant and early-motion protocol patients (P < .01). Overall, patients who were noncompliant with the shoulder immobilizer were 8.2 times more likely to have a failed repair on magnetic resonance imaging. Patients with better QOL shortly after arthroscopic rotator cuff repair were more likely to have retears by 6 months.
Preoperative and postoperative ASES, SST, and SANE scores were similar in patients who did and did not have retears of their rotator cuffs at 6 months postoperatively for all scores at all time points (see below).
Comment: The article states, "patients with better QOL (lower WORC scores) 6 weeks after arthroscopic rotator cuff repair experienced a much easier postoperative course in terms of improved QOL, but they were more likely to have retears by 6 months". However, in that the postoperative MRI's were performed only at 6 months, it is possible that the retears occurred earlier. Since the WORC measures pain, stiffness, and mobility, the greater quality of life (lower WORC scores) experienced at 6 weeks in the patients with retears may be, in fact, due to the failure of the repair with loss of the tension in the repair (which could contribute to postoperative pain and stiffness).
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