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ORIGINAL ARTICLE
Year : 2020  |  Volume : 20  |  Issue : 2  |  Page : 44-47

Outcome of rotator cuff repair surgery: A local study


Department of Orthopedic, College of Medicine, King Faisal University, Hofuf, Saudi Arabia

Date of Submission09-Sep-2020
Date of Decision01-Nov-2020
Date of Acceptance03-Dec-2020
Date of Web Publication20-Jan-2021

Correspondence Address:
Dr. Ali Alsakkak
Alhasa Hufof, Salman Alfarsi Street, King Fahd District
Saudi Arabia
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DOI: 10.4103/sjsm.sjsm_23_20

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  Abstract 

Background: Rotator cuff disease (RCD) is one among the various contributing causes of shoulder pain and results in weakness, restricting shoulder range of motion and impacting patient's quality of live negatively. Over decades, RCD has been one of the most common encountered conditions in orthopedic clinics and treated by upper-extremity surgeons.
Purpose: The purpose of the study is to identify patients diagnosed with RCD and to compare the clinical outcome of the pain score with functional impairment of shoulder pre- and post-operatively.
Study Design: This was a prospective cohort study.
Methods: A total of 44 patients who had undergone or would undergo surgical repair for rotator cuff (RC) tear in 6-month period were identified and enrolled in this study. Patients who refused to participate and those who had fracture in shoulder girdle were excluded from the study. Clinical evaluation of rotator cuff tear was done using a prevalidated data collection tool which is Oxford shoulder score (OSS) through structured interview in orthopedic clinic and the oss score was measured pre- and post-operatively.
Results: Forty-four patients with RCD were included in this study. The mean age was 52.91 ± 7.562 years and 55.7% of them were males. OSS was applied before and after the surgery. The lower the score means the higher the level of pain and activity restriction. We found a great and significant increase in the score after the surgery (45.56) compared to the score before the surgery (11.18).
Conclusion: Surgical repair of RC tear produced satisfactory clinical outcomes in reducing pain and improving the overall condition.

Keywords: Cuff, repair, rotator, shoulder


How to cite this article:
Hamam NA, Alsakkak A, Buhlaigah A, Bosror S. Outcome of rotator cuff repair surgery: A local study. Saudi J Sports Med 2020;20:44-7

How to cite this URL:
Hamam NA, Alsakkak A, Buhlaigah A, Bosror S. Outcome of rotator cuff repair surgery: A local study. Saudi J Sports Med [serial online] 2020 [cited 2021 Mar 7];20:44-7. Available from: https://www.sjosm.org/text.asp?2020/20/2/44/307520




  Introduction Top


Musculoskeletal system complaints present frequently in all types of populations. Shoulder complaints are one of the most common types of complaints faced by surgeons. The clinical presentation is described as pain and limitation of shoulder function, particularly during the action of elevation and external rotation of shoulder joint. Rotator cuff (RC) plays an important part in the movements of the shoulder and in supporting and controlling essential daily moves, including flexion, abduction, and external and internal rotations. Moreover, all disabilities involving the RC are known as “RC disease” (RCD) and cause great pain and weakness in the shoulder movements, which decreases the range of motion of the shoulder and reduces the patient's quality of life.[1],[2] Shoulder pain can be caused by multiple factors varying from genetics to smoking. However, the most important factors causing shoulder disability and pain are laborious exercise, extreme and repetitive activities requiring the arm to be over the head, trauma, and degenerative diseases. These various causes may affect a specific area of the shoulder, known as the RC, or the surrounding structures;[3] this poses the most frequent condition treated by upper-extremity surgeons.[4]

RCD is one among the most common musculoskeletal disorders in industrialized countries causing high direct and indirect costs. Although not all RC tears are symptomatic, RC tears are common injuries that cause patients pain and decreased range of motion, leading to significant morbidity.[5],[6]

In a study conducted on 664 patients, it was found that 22.1% of the sample size had full-thickness RC tears. Out of the 22.1% of subjects, symptomatic RC tears accounted for 51 cases while asymptomatic tears for 96 patients. The prevalence of RC tears was found to be highest in older patients, in which 36.6% of the subjects were in their 80s, which concluded that the prevalence of tears is increased with age. Thirty-eight cases out of the subjects who had full-thickness RC tears had bilateral RC tears.[7] An estimated 272,148 patients underwent RC repair in the United States in 2006.[8]

To diagnose RCD, it requires evaluation of full medical history, physical examination, and imaging.[9] Treatment modalities vary between surgical and nonsurgical protocols to relieve pain and restore shoulder function.[10] RCD therapy begins with a course of noninvasive or conservative therapy, which includes applying heat or ice packs, home exercises, pain killers, and physiotherapy.[1] This treatment usually lasts 6–18 weeks, and it can result in complete recovery in a great percentage of the patients, especially if combined with physiotherapy.[11]

The evidence base to support the best approach for the treatment in atraumatic RC tears is small and contradictory. The study showed statistically significant improvement between differences in the operative and nonoperative groups. In a follow-up intent-to-treat analysis, the study concluded that it was not significant. Another study of the same subject randomized 173 patients with supraspinatus tears into operative and nonoperative groups. They reported no statistically significant differences in the clinical outcome.[12]

The purpose of this study is to identify patients diagnosed with RCD, to measure and compare the clinical outcome of the pain score with functional impairment of shoulder pre- and post-operatively, and to identify the determinants of patient satisfaction with the outcome after RC repair surgery.


  Methods Top


This is a prospective cohort follow-up study that included 44 patients with RCD conducted over a 6-month period from March 2020 to August 2020 in Almoosa Specialist Hospital in Alhasa Saudi Arabia. Data was collected using a pre-validated data collection tool which is Oxford shoulder score (OSS) through structured interview pre-operative evaluation and post-operative with an orthopedic consultant in the clinic and scored to compare the outcome. All patients attended for various reasons including preoperative assessment, follow-ups, and physiotherapy sessions.

Regarding the inclusion and exclusion criteria, the study included all the patients in the orthopedic clinic with RCD who underwent or would undergo shoulder surgery in 6-month period. They were asked to participate in this study. Excluded from the study will be all patients who refused to participate and who have had fracture in the shoulder girdle. The data were put in an excel sheet and were analyzed by SPSS software (SPSS Inc., Chicago, USA). A paired sample t-test will be used to compare between the mean score pre- and post-surgery.


  Results Top


The present study had been conducted over 44 patients with a mean age of 52.91 ± 7.562 years; 55.7% of them were males. Most of the patients were from urban residency (90.9%) with a university education (69.3%). Moreover, most of them were employed (79.5%) with high-income status (54.5%) [Table 1].
Table 1: Demographic factors of participants (n=44)

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In [Table 2], we show that most of the patients indicated that they had hypertension (54.5%), while 43.2% indicated that they did not complain any medical history.
Table 2: Medical conditions

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Moreover, in [Table 3], we compare patients between before and after RC repair surgery. We assessed clinical outcome of RC repair surgery using the OSS pre- and post-operation where the mean score for patients after surgery was 45.56 compared to 11.18 in those before surgery (P = 0.000 < 0.05).
Table 3: OSS mean score

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  Discussion Top


In this study, we aimed to identify the characteristics of patients with RCD and to compare the clinical outcome of the pain score with functional impairment of shoulder preoperatively and post-RC repair operation. Forty-four patients with RCD were included in this study; the mean age was 52.91 ± 7.562 years. Hence, even though RCD can occur at any given age, our study is consistent with the results of Minagawa et al.[7] and Jain et al.,[8] which both showed that RCD is more common in older people. This can be explained that as with aging, it is normal to have weakness and degenerative changes in the muscles which contribute massively to the development of RCD. Another point we have noticed is that 55.7% of patients in this study were males, this is also consistent with a previous study done by Minagawa et al.,[7] and this can be explained as males are more prone to do heavy lifting and labor work which puts more strain on their muscles and causes an over-use injury. Moreover, RCD can also occur because of sport activities and trauma,[13] and this can explain why males represent more patients than females in our sample. However, another study is needed to study the etiological aspect of RCD as our study did not focus on that aspect. Pain was found to be higher in those patients with comorbidities such as cardiovascular diseases,[14] and in our sample, hypertension is the most common comorbidity. This is consistent with another study done by Saccò et al.,[15] which showed a connection between hypertension and elevation of feeling of chronic pain.

In this study, we used the OSS to assess the outcomes of RC repair surgery by applying the scale before and after the surgery. The lower the score means the higher level of pain and less restlessness. We found a great and significant increase in the score after the surgery compared to the score before the surgery (45.56 compared to 11.18). This indicates the successfulness of the surgery in improving the function and reducing the pain of patients, especially when doing day-to-day living activities. Many studies used different tools to assess the pain and found a great improvement after the surgery. In one study, they used the tool of the American Shoulder and Elbow Surgeons (ASES) which showed an increase of ASES score by 39.7 on average after RC repair surgery in elderly patients, which shows that surgery has a positive outcome on patients with RCD.[14] Using visual analog scale (VAS), a study conducted in 2019 where the mean score of VAS was improved from 8.4 to 1.04 (P < 0.001) at the final follow-up, indicating significant improvement in shoulder function, with a low complication rate.[16]

This study had some limitations including the small sample size of 44 patients. Another limitation is that most of the patients included are old, so further studies should include a bigger sample size with more distribution among different age intervals. Another limitation is the depending on patient subjective self-reported tools to assess level of pain; some patients may overestimate their pain to have more attentions to their conditions, which may affect our results. However, self-reported tools are the most reliable methods to assess the level of pain as pain is an intrinsic feeling that could not be assessed by medical tools. To solve the last limitation, we depend on mean and standard deviation to minimize this factor. This is the first study done to evaluate the clinical outcome of RC repair surgery by applying the OSS in Saudi Arabia, so further studies are needed in this topic to compare the results.


  Conclusion Top


Older age is a risk factor form RCD that is accompanied with pain and disabilities in preforming daily habits. However, the results in our study showed the success of RC repair surgery in reducing pain and improving the overall condition. Further studies should include bigger sample size to assess the factors related to failure or success of the RC repair surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Hopman K, Krahe L, Lukersmith S, McColl A, Vine K. Clinical practice guidelines for the management of rotator cuff syndrome in the workplace. Port Macquarie (Australia): University of New South Wales. 2013. p. 80.  Back to cited text no. 1
    
2.
Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther 2016;23:57-68.  Back to cited text no. 2
    
3.
Alruthia Y, Alghadeer S, Balkhi B, Almalag HM, Alsobayel H, Alodaibi F, et al. Efficacy of acetaminophen versus ibuprofen for the management of rotator cuff-related shoulder pain: Randomized open-label study. Saudi Pharm J 2019;27:882-8.  Back to cited text no. 3
    
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Jarrett CD, Schmidt CC. Arthroscopic treatment of rotator cuff disease. J Hand Surg 2011;36:1541-52.  Back to cited text no. 4
    
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Longo UG, Berton A, Papapietro N, Maffulli N, Denaro V. Epidemiology, genetics and biological factors of rotator cuff tears. Med Sport Sci 2012;57:1-9.  Back to cited text no. 5
    
6.
Kakazu R, Kenter K. Traumatic rotator cuff tears. In: Shoulder and Elbow Trauma and its Complications. University of Cincinnati, Cincinnati, OH, USA; Woodhead Publishing: 2015. p. 37-56.  Back to cited text no. 6
    
7.
Minagawa H, Yamamoto N, Abe H, Fukuda M, Seki N, Kikuchi K, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop 2013;10:8-12.  Back to cited text no. 7
    
8.
Jain NB, Higgins LD, Losina E, Collins J, Blazar PE, Katz JN. Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskelet Disord 2014;15:4.  Back to cited text no. 8
    
9.
Bruns J, Henning R, Behrens P. Arthrolysis of the shoulder for ruptures of the rotator cuff. Int Orthop 1997;21:157-60.  Back to cited text no. 9
    
10.
Baysal D, Balyk R, Otto D, Luciak-Corea C, Beaupre L. Functional outcome and health-related quality of life after surgical repair of full-thickness rotator cuff tear using a mini-open technique. Am J Sports Med 2005;33:1346-55.  Back to cited text no. 10
    
11.
Cole BJ, McCarty LP 3rd, Kang RW, Alford W, Lewis PB, Hayden JK, et al. Arthroscopic rotator cuff repair: Prospective functional outcome and repair integrity at minimum 2-year follow-up. J Shoulder Elbow Surg 2007;16:579-85.  Back to cited text no. 11
    
12.
Jain NB, Ayers GD, Koudelková H, Archer KR, Dickinson R, Richardson B, et al., Operative vs. nonoperative treatment for atraumatic rotator cuff tears: A trial protocol for the arthroscopic rotator cuff pragmatic randomized clinical trial. JAMA Network Open 2019;2:e199050.  Back to cited text no. 12
    
13.
Harris JD, Pedroza A, Jones GL. MOON (multicenter orthopedic outcomes network) shoulder group: Predictors of pain and function in patients with symptomatic, atraumatic full-thickness rotator cuff tears: a time-zero analysis of a prospective patient cohort enrolled in a structured physical therapy program. Am J Sports Med 2012;40:359-66.  Back to cited text no. 13
    
14.
Fang, Y, Zhang Q. Outcomes after rotator cuff repair in the elderly as assessed by the American Shoulder and Elbow Surgeons shoulder score. Clinics 2020;75.  Back to cited text no. 14
    
15.
Saccò M, Meschi M, Regolisti G, Detrenis S, Bianchi L, Bertorelli M, et al. The relationship between blood pressure and pain. J Clin Hypertens (Greenwich, Conn.) 2013;15:600-5.  Back to cited text no. 15
    
16.
Babhulkar A, Ravikumar Patil P, Kumar V. Clinical outcome of arthroscopic rotator cuff repair in patients aged 70 years and older. Int J Orthopaedics 2019;6:1141-5.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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