This document summarizes a study on predictors of outcomes for rotator cuff repair surgery. The study found that several factors were associated with lower patient-reported outcome scores after surgery, including female gender, more severe tendon retraction, higher grades of fatty degeneration, and larger tear sizes. The study had a small sample size and the author plans to conduct a larger follow up study to confirm these findings and potentially identify other predictive factors through multivariate analysis. The goal is to better understand what influences outcomes after rotator cuff repair.

1. Predictors of Outcomes of Rotator
Cuff Repair
Jack Turnbull, 4th Year Medical Student, CMFT, July 2014.
Supervisor: Professor Lennard Funk.

2. Overview of Presentation
! Introduction/Project Aims
! Background
! Rotator cuff function and pathology
! Management
! Outcome Scores
! Results
! Conclusions

3. Project Aims
! To retrospectively study results of arthroscopic rotator
cuff repair, and discover any factors that influence
outcomes.
! Patient-Related Factors
! Age, gender, grade of fatty degeneration
! Injury related factors
! Tear size, shape, tendon retraction.
! Procedure related factors
! Bone anchors used, LHB treatment,

4. Background
! Rotator Cuff
! Subscapularis, Supraspinatus, Infraspinatus, Teres Minor.
! Stabilise Glenohumeral joint, contribute to movement.

5. Background Contd.
! Tear Pathology
! Intrinsic factors
! Poor quality tissue due to fatty infiltration, poor vasculature etc.
! Extrinsic factors
! Subacromial impingement.
! Trauma.
! Internal impingement.
! Management
! Conservative
! Analgesia, relative rest, physiotherapy.
! Surgical
! Rotator cuff repair +/- Subacromial decompression

6. Background Contd.
! Outcome Scores Used
! Oxford Shoulder Score
! 12 item patient reported outcome questionnaire. Subjective
questions regarding pain and activities of daily living.
! Constant-Murley Shoulder Score
! Subjective patient reported outcome questions on pain and
activities of daily living and objective section on strength and
range of movement.
! Pain Score
! 0-15. 0= No pain 15=Worst pain.
! Satisfaction Score
! 0-10. 0= Not satisfied, 10= Very satisfied.

7. Methods
! Data collected from secure database (BlueSpier), patients
were emailed to respond using a Shoulder Assessment
Form, which was used to calculate post-op scores.
! 375 patients with rotator cuff repair between over a period of
3 years (2010-2013) were identified.
! Only 43 patients responded in time out of approximately 160
contacted.
! Statistics was done using SPSS version 20.0 for Windows.
! Independent and paired samples t tests and one way ANOVA were
all used.

8. Results
! Significant factors
! Female gender scored less for Oxford score. (p= 0.04, independent
samples t-test)
! Severe tendon retraction scored lower Oxford scores (p=<0.01,
independent samples t-test)
! Goutallier grade of fatty degeneration 3 or 4 (more severe) scored
lower Oxford (p=0.01) and Constant (p=0.02) scores (independent
samples t-test).
! Greater tear width (2-4cm transverse) scored lower Oxford (p=<0.01)
and Constant (p= 0.04) scores (independent samples t-test).
! Number of bone anchors (3 or more) was linked with lower Constant
scores (p=0.03), but numbers were low (one-way ANOVA).

9. Conclusions
! From this pilot study, several factors were identified that
negatively affected outcome scores.
! Gender, fatty degeneration, tendon retraction, tear width and
tentatively, number of bone anchors used.
! These factors have all been reported elsewhere in
literature.
! There are other factors that were not significant in this
study that are widely reported as significant.
! Age, LHB treatment, cuff quality, multiple tendon
involvement.

10. Further Work
! This study had low numbers.
! A full study is planned to confirm our conclusions, add
statistical power, unmask any other correlations and
reduce sampling bias.
! Factors were only considered independently.
! Perform multivariate analysis when enough numbers for
full study have been achieved.
! Only most recent follow up was used (mean 2.5
years)
! Attempt to perform analysis at 3 month and 6 month
intervals in the full study, should sufficient numbers be
achieved.

11. THANK YOU.
QUESTIONS?
Acknowledgements
I would like to thank Professor Lennard Funk and Tanya Mackenzie for their
assistance and supervision during the Project Option period.