British Elbow and Shoulder Meeting, Sheffield, June 2015. 

1. Outcomes of cuff repairs… what
to expect?
British Elbow and Shoulder
Meeting, Sheffield, June 2015.
Mohamed Imam, Vijayaraj Ramasamy, Rupen Dattani, Mohamed
Elsherbiny and Vipul Patel

2. No Disclosures
Relevant to this study

3. O Patient expectations are important for
improved outcomes
O Patients’ expectations prior to
shoulder surgery
Why is it important ?
Kravitz RL: Measuring patients' expectations and requests. Ann Int Med 2001
Mancuso et al Patients' expectations of shoulder surgery JSES 2002

4. So if
expectations
are fulfilled

5. Aims & Objectives
O To evaluate what patients expect from rotator cuff
repair
O The extent of fulfilment of preoperative expectations
O To determine the relationship between expectations
and Patient-reported outcome measures (PROMs)
before and after surgery.

6. Subjects and Methods
• 80 patients – Single surgeon (V.P.) with a mean age of
62+/- 11 years at time of surgery
• 41 had small to medium tears while 39 had large tears
as assessed by both scans and arthroscopy
• PreOp: HSS Expectations Survey, Oxford Shoulder Score
(OSS) and EQ5D.
• At 6 months and 2 years after surgery, patients
completed a modified Shoulder Surgery Expectations
Fulfilment Survey, OSS, EQ5D and satisfaction survey
(0-100%).
78 and 51 Patients replied post surgery at 6 months and 2
years respectively

7. Figure 2 The 17-item Hospital for Special Surgery Shoulder Surgery Expectations Survey. (Used with permission. Copyright 2000, The
Hospital for Special Surgery.)
J Shoulder Elbow Surg Mancuso et al 547
Volume 11, Number 6

8. Statistical Analysis
• Preoperative and postoperative PROMs data were
compared with paired t-tests.
• The relationship between preoperative
expectations, postoperative expectations fulfilment
and PROMs were examined using multiple logistic
regression.

9. Results
OSS improved from a preoperative mean of 24.5
to 43.2 at 2 years (P<0.01)
EQ5D improved from 0.47 preoperatively to 0.90
at final follow-up (P<0.01). Median postoperative
satisfaction was 90%.

12. Results
O Failure of Repair:
1 patient----- Reverse Shoulder arthroplasty
O Surgical Emphysema and Pneumothorax
1 patient
O Stiffness – 7 patients only 1
Needed capsular release
Complications
6
1 Managed by
Physio
Capsular
Release

13. Preoperatively
- Over 80% of patients rated 8 of 17
expectations as “very” or “somewhat”
important
- at 6 months 5 of 8 important
expectations and
- at 2 years all 8 important expectations
were rated as fulfilled by over 80% of
patients.

14. Top Expectations
“Relief of daytime and
night-time pain”
“The shoulder to be
the way it was before”
“Improve range of
movements”

15. Pre-OP Expectations
NOT correlated with age, gender
or preoperative PROMS

16. PreOP Expectations
Nor did they predict postoperative
PROMS

17. However
There was a statistically significant
correlation between fulfilment of
expectations after surgery and patient
satisfaction.

18. Discussion
High preoperative and postoperative met
expectations were also positively correlated with
patient satisfaction.

19. Discussion
- Greater preoperative expectations correlated with
better postoperative performance
- Greater expectations were a significant independent
predictor of both better performance at one year and
greater improvement on the

20. Our Findings versus others
These studies found that pre-op expectations did influence post
outcome whereas ours did not.
One of the reasons could be the use of different tools i.e. they used the
MODEMS questionnaire for expectations and SST, DASH and SF36 for
PROMS. They did not look at expectations fulfillment and that makes our
study unique.

21. Limitations
O Other cofounding factors
O The reproducibility and
validity of the specific
visual analogue scales
utilized in this study have
not been validated

22. What do patients expect of rotator cuff
repair and does it matter?!

23. O Expectations: an important factor that
appears to independently affect the outcome
of rotator cuff repair
O Patients whose expectations of surgery are
fulfilled achieve a high degree of satisfaction
after rotator cuff repair
O Patients may be reassured that surgery is
successful in fulfilling expectations that are
rated as important but it may take up to 2
years for these expectations to be met.
Conclusions

24. Recommendations
O Intensive preoperative education should be
carried out and directed at patients with
inappropriate expectations
O Significant concerns that need attention in
future research are the theoretic outlining of
patient expectations, the assessment of their
expectations and the correlation of these
expectations with other cofounding factors.

25. Thank You
Mohamed.Imam@aol.com