Patient-Related Risk Factors Predict Outcomes After Arthroscopic Rotator Cuff Repair

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

Corresponding Author

Thomas W. Throckmorton, MD

1400 S. Germantown Road Germantown, TN 38138 P: 901-759-3110 F: 901-759-3195 tthrockmorton@campbellclinic.com

Background/Hypothesis

Several factors are known to impact outcomes of arthroscopic rotator cu repair; however, little is known about patient-specifi c, potentially modifi able risk factors that may be of signifi cance. Based on prior study of the early post-operative e ects 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 cu repair.

Methods

After Institutional Review Board (IRB) approval, records review identifi ed 75 primary arthroscopic rotator cu 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-specifi c 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 signifi cant.

Results

Of the variables studied, preoperative smoking was a signifi cant 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 signifi cant di erence 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 signifi cantly inferior pain scores or functional outcomes at most recent follow-up (all p>0.05). There were no statistically signifi cant di erences noted regarding ROM or strength for any of the risk factors studied.

Conclusions

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 cu repair. Moreover, these represent potentially modifi able 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.

JOSEPH T. CLINE, MD

Hometown: Raleigh, North Carolina Undergraduate Institution: Davidson College Medical School: University of North Carolina School of Medicine Dr. Cline is an only child, and his decision to choose medicine as a career came naturally - his father is a general surgeon, and his mother is a dermatologist. Dr. Cline met his wife, Meg, at Davidson College where he was fortunate enough to have the apartment below hers. They were married in 2018 and have one son - Robert Tucker Cline, who was born on April 7, 2021. Meg is the Director of Summer Programming at Lausanne Collegiate School. When asked why he chose medicine as a career: I grew up around medicine with both my parents being doctors. I always enjoyed meeting their patients out in the community and having them go out of their way to tell me how one of my parents had helped them in some way. I knew I wanted a career where I could have a similar impact on people’s lives. And why he chose orthopaedics as a specialty: Orthopaedics allows us to make a tangible, often immediate, diff erence in our patients’ lives. I loved the idea that I could help a patient struggling with a debilitating problem to not only get out of pain, but go back to being active and enjoying their life. Plans After Campbell: Dr. Cline will complete an Adult Reconstruction Fellowship at Rush University in Chicago. Dr. Cline adds: Honestly, it’s impossible to name everyone deserving of thanks. The Campbell Clinic has many unique features that make it such an amazing place to train, but I think the people we get the privilege of learning from and with stand apart the most. From the trauma and pediatric staff who see us through the busy summer nights on call to the joints staff who helped guide me on my chosen career path, I’m incredibly grateful for everyone here.