Factors Affecting Satisfaction and Shoulder Function in Patients with a Recurrent Rotator Cuff Tear

Background: It is widely accepted that most patients treated with rotator cuff repair do well regardless of the integrity of the repair. The purpose of this cross-sectional study was to reexamine this concept and identify the factors affecting the outcomes of patients with a recurrent tear. Methods: A cohort of patients who had been treated with rotator cuff repair completed a survey regarding satisfaction with the operatively treated shoulder, physical activity, and shoulder function. Ultrasonography was performed to determine rotator cuff integrity. Patients were divided into three age categories: younger than fifty-five years, fifty-five to sixty-five years, and sixty-six years or older. The relationships of the outcomes to patient age, repair integrity, and other demographic factors were analyzed. Results: Forty-seven (26%) of the 180 enrolled patients had a retear, defined as a full-thickness defect. In each age category, the satisfaction, ASES (American Shoulder and Elbow Surgeons), and SST (Simple Shoulder Test) scores in the retear group were significantly poorer than those in the no-retear group (p<0.05). Within the retear group, all three scores were significantly better in the oldest age category (p<0.05); there were no significant differences among the age categories within the no-retear group (p>0.05). Simple regression analysis showed that younger age, a Workers' Compensation claim, and lower education level were significant predictors of poorer scores in patients with a retear (p<0.05). Multiple regression analysis of the retear group showed that (1) lower education level and a Workers' Compensation claim were independent predictors of a poorer satisfaction score; (2) lower education level, younger age, and a Workers' Compensation claim were independent predictors of a poorer ASES score; and (3) lower education level was the only independent predictor of a poorer SST score (p<0.01 for all). Conclusions: The presence of a retear negatively affected the clinical outcomes following rotator cuff repair. This finding refutes the widely held concept that patients typically do well regardless of the repair integrity following rotator cuff repair. In patients with a retear, nonanatomic factors including younger age, lower education level, and a Workers' Compensation claim were associated with poorer outcomes.