Joseph T. Cline, MD1 Dima Falkner, MS2 Tyler Brolin, MD1 Richard Smith, PhD1 Frederick Azar, MD1 Thomas W. Throckmorton, MD1 1
University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering Memphis, Tennessee
2
University of Tennessee Health Science Center College of Medicine Memphis, Tennessee
Patient-Related Risk Factors Predict Outcomes After Arthroscopic Rotator Cuff Repair Background/Hypothesis Several factors are known to impact outcomes of arthroscopic rotator cuff repair; however, little is known about patient-specific, potentially modifiable risk factors that may be of significance. Based on prior study of the early post-operative effects of these factors, we hypothesized that certain preoperative patient characteristics would have an impact on pain and functional outcomes at a minimum of 2 years follow-up after primary arthroscopic rotator cuff repair.
Methods After Institutional Review Board (IRB) approval, records review identified 75 primary arthroscopic rotator cuff repairs with at least 2 years (2.2-6.5 years) of clinical follow-up done at our institution by a single shoulder and elbow trained surgeon. Based on previous studies of short-term outcomes, we included pre-operative tobacco use, opioid use, alcohol use, disability claims, mood disorders (depression/anxiety), worker’s compensation claims, and obesity as patient-specific variables. Outcomes measures included visual analog (VAS) pain scores, American Shoulder and Elbow Surgeons (ASES) scores, Single Assessment Numeric Evaluation (SANE) scores, range of motion (ROM) and strength at a minimum of 2 years follow up. Risk factor analysis was performed using Student t-tests and ANOVA with p<0.05 considered statistically significant.
Results Of the variables studied, preoperative smoking was a significant predictor of pain at most recent follow-up (VAS 4.5 vs 1.3, p=0.009). Smoking patients also had worse ASES (62.4 vs 84.0, p=0.004) and SANE (63.0 vs 83.4, p=0.011) scores at most recent follow-up. Preoperative opioid use also trended toward worse pain (VAS 2.6 vs 1.3, p=0.06) and ASES (74.1 vs 84.9 p= 0.074) scores at minimum 2-year follow-up, with no significant difference in SANE (76.1 vs 82.8, p=0.27). However, alcohol use, disability claims, mood disorders, worker’s compensation claims, and obesity were not associated with significantly inferior pain scores or functional outcomes at most recent follow-up (all p>0.05). There were no statistically significant differences noted regarding ROM or strength for any of the risk factors studied.
Conclusions Corresponding Author Thomas W. Throckmorton, MD 1400 S. Germantown Road Germantown, TN 38138 P: 901-759-3110 F: 901-759-3195 tthrockmorton@campbellclinic.com
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Pre-operative smoking and opioid use were both associated with increased pain and inferior function at a minimum of 2 years following primary arthroscopic rotator cuff repair. Moreover, these represent potentially modifiable risk factors that can be addressed before operative intervention to optimize outcomes and maximize value. Alcohol use, disability claims, mood disorders, worker’s compensation claims, and obesity were not associated with worse pain or functional scores at a minimum of 2 years follow-up in this study.
CAMPBELL ORTHOPAEDIC JOURNAL • VOLUME 7, 2021
