Factors affecting outcome after structural failure of repaired rotator cuff tears.

Abstract

Failure of structural healing is not infrequent after rotator cuff repair and often is not associated with clinical outcome. The goals of this study are to describe outcomes in a cohort of patients with a failed rotator cuff repair and to evaluate factors associated with clinical outcome. This was a retrospective study of all patients with failure of structural integrity after rotator cuff surgical repair. A threshold American Shoulder and Elbow Surgeons (ASES) score of 80 points was used to allocate patients into either the successful (≥80 points; Group 1) or unsuccessful (<80 points; Group 2) cohorts. Demographics, patient-centered instruments for shoulder function, radiographic parameters, and shoulder motion were compared between groups. On the basis of the postoperative ASES score, thirty-three patients (54.1%) were included in Group 1 and twenty-eight patients (45.9%) were included in Group 2. Fifteen patients (53.6%) in Group 2 reported a labor-intensive occupation compared with two patients (6.1%) in Group 1 (p < 0.001). Multiple regression analysis demonstrated that labor-intensive occupation (odds ratio [OR], 202.3; p = 0.026), preoperative Simple Shoulder Test (SST) score (OR, 0.50; p = 0.028), and preoperative external rotation (OR, 0.91; p = 0.027) were associated with inclusion in Group 2. Age and other demographic variables, including sex, dominant-sided surgery, and medical comorbidities, were similar for the groups. Successful outcomes were achieved in 54% of patients with failed rotator cuff repair. Those who self-identified their occupation as being labor-intensive represented a special group of patients who are at high risk for a poor outcome after a failed rotator cuff repair.