Document Detail


The long-term outcome of recurrent defects after rotator cuff repair.
MedLine Citation:
PMID:  19752204     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Christopher C Dodson; Alison Kitay; Nikhil N Verma; Ronald S Adler; Joseph Nguyen; Frank A Cordasco; David W Altchek
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Publication Detail:
Type:  Journal Article     Date:  2009-09-14
Journal Detail:
Title:  The American journal of sports medicine     Volume:  38     ISSN:  1552-3365     ISO Abbreviation:  Am J Sports Med     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-06     Completed Date:  2011-01-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7609541     Medline TA:  Am J Sports Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  35-9     Citation Subset:  IM    
Affiliation:
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 10021, USA. dodsonc@hss.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arthroscopy / adverse effects,  statistics & numerical data
Athletic Injuries / rehabilitation,  surgery*,  ultrasonography
Female
Health Status Indicators
Humans
Male
Middle Aged
Pain Measurement
Prospective Studies
Questionnaires
Range of Motion, Articular
Recurrence
Rotator Cuff / injuries,  surgery*
Time Factors
Treatment Failure*
Comments/Corrections
Comment In:
Am J Sports Med. 2010 Jul;38(7):NP8-9   [PMID:  20601603 ]
Am J Sports Med. 2010 Jan;38(1):23-4   [PMID:  20051507 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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