Abstract
BackgroundComorbidities and socioeconomic issues impact outcome of rotator cuff tear (RCT) repair. There are no data on RCT repair outcome from developing regions. We determined the impact of obesity and smoking following RCT repair in a low-income population.MethodsThis is a retrospective case series. Forty-seven shoulders of 42 patients subjected to open or arthroscopic repair of a RCT with a minimum of 2 years follow-up were cross-sectionally evaluated. Patients were seen in the Orthopaedic Service of the Hospital Geral de Fortaleza-CE, Brazil between March and September 2018. RCT were classified as partial or full-thickness lesions. Fatty infiltration (Goutallier) and tendon retraction (Patte) were recorded as well as obesity (BMI > 30), literacy [>/≤ 8 school years (SY)] and smoking status 6 months prior to surgery (present/absent). Outcomes included pain (visual analogue scale; VAS, 0–10 cm), range of motion [active forward flexion and external rotation (ER)], UCLA and ASES scoring.ResultsPatients were 59.9 ± 7.4 years-old, 35(74.4%) female with 19 (17.1–30.2 IQR) median of months from diagnosis to surgery and 25 median months of follow-up (26.9–34.0 IQR); over 90% declared < 900.00 US$ monthly family income and two-thirds had ≤8 SY. Forty patients (85.1%) had full-thickness tears, 7 (14.9%) had Goutallier ≥3 and over 80% had < Patte III stage. Outcomes were similar regardless of fatty infiltration or tendon retraction staging. There were 17 (36.1%) smokers and 13 (27.6%) obese patients. Outcome was similar when comparing obese vs non-obese patients. Smokers had more pain (P = 0.043) and less ER (P = 0.029) with a trend towards worse UCLA and ASES scores as compared to non-smokers though differences did not achieve minimal clinically important difference (MCID) proposed for surgical RCT treatment. After adjusting for obesity, VAS and ER values in smokers were no longer significant (P = 0.2474 and 0.4872, respectively).ConclusionsOur data document outcomes following RCT repair in a low-income population. Smoking status but not obesity impacted RCT repair outcome though not reaching MCID for surgical treatment.
Highlights
Rotator cuff tear (RCT) ranks first among the causes of shoulder pain and dysfunction
Patients with acute posttraumatic rotator cuff tear (RCT) lesions are the best candidates for surgical repair, but those younger than 65 years of age presenting with symptomatic larger lesions (> 1–1.5 cm) are highly considered for surgery [1, 2]
Time from diagnosis to surgery can be delayed and access to rehabilitation facilities is far from ideal [9]. Given that those shortcomings could affect surgical results in patients subjected to RCT repair we studied the outcome following at least 2 years of RCT repair in a low-income, low-literacy population
Summary
Rotator cuff tear (RCT) ranks first among the causes of shoulder pain and dysfunction. Comorbidities were shown to modify the clinical picture of patients with a RCT, few studies addressed their impact on the outcome after surgical repair [3]. A retrospective study evaluating the influence of cigarette smoking in RCT found a positive association with increased severity at presentation and an inferior response to treatment, as compared to non-smokers [5]. Time from diagnosis to surgery can be delayed and access to rehabilitation facilities is far from ideal [9] Given that those shortcomings could affect surgical results in patients subjected to RCT repair we studied the outcome following at least 2 years of RCT repair in a low-income, low-literacy population. Comorbidities and socioeconomic issues impact outcome of rotator cuff tear (RCT) repair. We determined the impact of obesity and smoking following RCT repair in a low-income population
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