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The long-term outcome of recurrent defects after rotator cuff repair.
Am J Sports Med. 2010 Jan; 38(1):35-9.AJ

Abstract

BACKGROUND

Retears of the rotator cuff are not uncommon after arthroscopic and mini-open rotator cuff repairs. In most studies, the clinical results in patients with persistent defects demonstrated significantly less pain and better function and strength compared with their preoperative state at an early follow-up.

HYPOTHESIS

The clinical and structural outcomes of patients with known rotator cuff defects will remain unchanged after a longer period of follow-up.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

This study was performed in 15 patients (18 shoulders) from a previous study who had recurrent rotator cuff defects 3.2 years after repair. Each patient completed the American Shoulder and Elbow Surgeons Scoring Survey, the Simple Shoulder Test, the L'Insalata Scoring Survey, and a visual analog scale for pain. Eleven patients (13 shoulders) were clinically reexamined at an average of 7.9 years for range of motion and strength, with targeted ultrasound.

RESULTS

At the 7.9 year follow-up the average scores were 95 (American Shoulder and Elbow Surgeons), 95 (L'Insalata), 11 (Simple Shoulder Test), and 0 (visual analog for pain), which were not statistically significantly different from the scores at 3.2 years. There was no change in the average range of motion; however, there was a statistically significant reduction in forward flexion strength and external rotation strength, as measured by a dynamometer. The average external rotation strength decreased by a mean of 42% and the mean forward flexion strength decreased by a mean of 45% (P < .001). Furthermore, there was a statistically significant increase in the mean size of the defect, from 273 mm(2) to 467 mm(2) (P < .001). Finally, the size of the defect increased in all patients, and no defects healed structurally.

CONCLUSION

At an average of 7.9 years, patients with recurrent defects after rotator cuff repair still had an improvement in terms of pain, function, and satisfaction. However, the rotator cuff defect significantly increased in size, and there was a progression of strength deficits. These findings suggest that patients with recurrent defects can remain asymptomatic over the long term but will predictably lose strength in the involved extremity. Furthermore, the study demonstrated that defects after rotator cuff repair increase in size but often remain asymptomatic.

Authors+Show Affiliations

Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 10021, USA. dodsonc@hss.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19752204

Citation

Dodson, Christopher C., et al. "The Long-term Outcome of Recurrent Defects After Rotator Cuff Repair." The American Journal of Sports Medicine, vol. 38, no. 1, 2010, pp. 35-9.
Dodson CC, Kitay A, Verma NN, et al. The long-term outcome of recurrent defects after rotator cuff repair. Am J Sports Med. 2010;38(1):35-9.
Dodson, C. C., Kitay, A., Verma, N. N., Adler, R. S., Nguyen, J., Cordasco, F. A., & Altchek, D. W. (2010). The long-term outcome of recurrent defects after rotator cuff repair. The American Journal of Sports Medicine, 38(1), 35-9. https://doi.org/10.1177/0363546509341654
Dodson CC, et al. The Long-term Outcome of Recurrent Defects After Rotator Cuff Repair. Am J Sports Med. 2010;38(1):35-9. PubMed PMID: 19752204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The long-term outcome of recurrent defects after rotator cuff repair. AU - Dodson,Christopher C, AU - Kitay,Alison, AU - Verma,Nikhil N, AU - Adler,Ronald S, AU - Nguyen,Joseph, AU - Cordasco,Frank A, AU - Altchek,David W, Y1 - 2009/09/14/ PY - 2009/9/16/entrez PY - 2009/9/16/pubmed PY - 2011/1/7/medline SP - 35 EP - 9 JF - The American journal of sports medicine JO - Am J Sports Med VL - 38 IS - 1 N2 - BACKGROUND: Retears of the rotator cuff are not uncommon after arthroscopic and mini-open rotator cuff repairs. In most studies, the clinical results in patients with persistent defects demonstrated significantly less pain and better function and strength compared with their preoperative state at an early follow-up. HYPOTHESIS: The clinical and structural outcomes of patients with known rotator cuff defects will remain unchanged after a longer period of follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This study was performed in 15 patients (18 shoulders) from a previous study who had recurrent rotator cuff defects 3.2 years after repair. Each patient completed the American Shoulder and Elbow Surgeons Scoring Survey, the Simple Shoulder Test, the L'Insalata Scoring Survey, and a visual analog scale for pain. Eleven patients (13 shoulders) were clinically reexamined at an average of 7.9 years for range of motion and strength, with targeted ultrasound. RESULTS: At the 7.9 year follow-up the average scores were 95 (American Shoulder and Elbow Surgeons), 95 (L'Insalata), 11 (Simple Shoulder Test), and 0 (visual analog for pain), which were not statistically significantly different from the scores at 3.2 years. There was no change in the average range of motion; however, there was a statistically significant reduction in forward flexion strength and external rotation strength, as measured by a dynamometer. The average external rotation strength decreased by a mean of 42% and the mean forward flexion strength decreased by a mean of 45% (P < .001). Furthermore, there was a statistically significant increase in the mean size of the defect, from 273 mm(2) to 467 mm(2) (P < .001). Finally, the size of the defect increased in all patients, and no defects healed structurally. CONCLUSION: At an average of 7.9 years, patients with recurrent defects after rotator cuff repair still had an improvement in terms of pain, function, and satisfaction. However, the rotator cuff defect significantly increased in size, and there was a progression of strength deficits. These findings suggest that patients with recurrent defects can remain asymptomatic over the long term but will predictably lose strength in the involved extremity. Furthermore, the study demonstrated that defects after rotator cuff repair increase in size but often remain asymptomatic. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/19752204/The_long_term_outcome_of_recurrent_defects_after_rotator_cuff_repair_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546509341654?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -