Predictors of Outcomes of Rotator Cuff Repair

Jack Turnbull, 4th Year Medical Student, CMFT, July 2014. Supervisor: Professor Lennard Funk.

Overview of Presentation! Introduction/Project Aims! Background

! Rotator cuff function and pathology! Management! Outcome Scores

! Results! Conclusions

Project Aims! To retrospectively study results of arthroscopic rotator

cuff repair, and discover any factors that influence outcomes.! Patient-Related Factors

! Age, gender, grade of fatty degeneration

! Injury related factors! Tear size, shape, tendon retraction.

! Procedure related factors! Bone anchors used, LHB treatment,

Background! Rotator Cuff

! Subscapularis, Supraspinatus, Infraspinatus, Teres Minor.! Stabilise Glenohumeral joint, contribute to movement.

Background Contd.! Tear Pathology

! Intrinsic factors ! Poor quality tissue due to fatty infiltration, poor vasculature etc.

! Extrinsic factors! Subacromial impingement.! Trauma. ! Internal impingement.

! Management! Conservative

! Analgesia, relative rest, physiotherapy.! Surgical

! Rotator cuff repair +/- Subacromial decompression

Background Contd.! Outcome Scores Used

! Oxford Shoulder Score! 12 item patient reported outcome questionnaire. Subjective

questions regarding pain and activities of daily living.! Constant-Murley Shoulder Score

! Subjective patient reported outcome questions on pain and activities of daily living and objective section on strength and range of movement.

! Pain Score ! 0-15. 0= No pain 15=Worst pain.

! Satisfaction Score! 0-10. 0= Not satisfied, 10= Very satisfied.

Methods! Data collected from secure database (BlueSpier), patients

were emailed to respond using a Shoulder Assessment Form, which was used to calculate post-op scores.

! 375 patients with rotator cuff repair between over a period of 3 years (2010-2013) were identified.

! Only 43 patients responded in time out of approximately 160 contacted.

! Statistics was done using SPSS version 20.0 for Windows.! Independent and paired samples t tests and one way ANOVA were

all used.

Results! Significant factors

! Female gender scored less for Oxford score. (p= 0.04, independent samples t-test)

! Severe tendon retraction scored lower Oxford scores (p=<0.01, independent samples t-test)

! Goutallier grade of fatty degeneration 3 or 4 (more severe) scored lower Oxford (p=0.01) and Constant (p=0.02) scores (independent samples t-test).

! Greater tear width (2-4cm transverse) scored lower Oxford (p=<0.01) and Constant (p= 0.04) scores (independent samples t-test).

! Number of bone anchors (3 or more) was linked with lower Constant scores (p=0.03), but numbers were low (one-way ANOVA).

Conclusions! From this pilot study, several factors were identified that

negatively affected outcome scores.! Gender, fatty degeneration, tendon retraction, tear width and

tentatively, number of bone anchors used.

! These factors have all been reported elsewhere in literature.

! There are other factors that were not significant in this study that are widely reported as significant.! Age, LHB treatment, cuff quality, multiple tendon

involvement.

Further Work! This study had low numbers.

! A full study is planned to confirm our conclusions, add statistical power, unmask any other correlations and reduce sampling bias.

! Factors were only considered independently.! Perform multivariate analysis when enough numbers for

full study have been achieved.! Only most recent follow up was used (mean 2.5

years)! Attempt to perform analysis at 3 month and 6 month

intervals in the full study, should sufficient numbers be achieved.

THANK YOU.

QUESTIONS?

AcknowledgementsI would like to thank Professor Lennard Funk and Tanya Mackenzie for their assistance and supervision during the Project Option period.