Compensation Status as a Risk Factor for Rotator Cuff Repair
It is an option for physicians to advise patients that the following factor correlates with less favorable outcomes after rotator cuff surgery: Worker’s Compensation Status
Rationale
Several authors94, 95, 96 have evaluated the effect of Workers’ compensation on surgical treatment for rotator cuff disease including acromioplasty for tendonitis and repair of full-thickness tears. Based upon one Level II study96and two Level III studies,97, 98 the work group has determined that it is an option for physicians to advise their patients that workers’ compensation status correlates with less favorable outcomes after rotator cuff repair.
One study96 prospectively evaluated 107 shoulders (23 of which were receiving workers’ compensation) at an average of 45 months postoperative from an open rotator cuff repair with the UCLA score. Both groups were comparable with regards to patient age, sex, tear size, preoperative strength and active motion. At final follow-up, patients receiving workers’ compensation had significantly worse UCLA scores compared to those not receiving workers’ compensation. Another study94 prospectively evaluated 106 patients (40 of which were receiving workers’ compensation) at an average of 32 months after arthroscopic acromioplasty for rotator cuff tendonitis with the ASES score, the Simple Shoulder Test and a VAS pain scale. The authors report no statistically significant differences between groups with regards to each of these outcomes although the AAOS work group re-calculated the statistics and found workers’ compensation patients had significantly worse SST and VAS pain scores than those not receiving a claim. The last study95 prospectively evaluated 24 patients (12 receiving workers’ compensation) at an average of 3 years postoperative from an open acromioplasty for rotator cuff tendonitis with UCLA scores. At final evaluation, workers’ compensation patients had significantly worse improvements in pain compared to those not receiving Workers’ compensation.
Based upon the above data, shoulder function as evaluated by the UCLA score, the Simple Shoulder Test and VAS pain scores were all inferior in workers’ compensation patients treated surgically for acromioplasty for rotator cuff tendonitis or rotator repairs compared to a non-workers’ compensation group. This data supports the option of advising patients that workers’ compensation status correlates with less favorable outcomes after rotator cuff surgery.
One study96 prospectively evaluated 107 shoulders (23 of which were receiving workers’ compensation) at an average of 45 months postoperative from an open rotator cuff repair with the UCLA score. Both groups were comparable with regards to patient age, sex, tear size, preoperative strength and active motion. At final follow-up, patients receiving workers’ compensation had significantly worse UCLA scores compared to those not receiving workers’ compensation. Another study94 prospectively evaluated 106 patients (40 of which were receiving workers’ compensation) at an average of 32 months after arthroscopic acromioplasty for rotator cuff tendonitis with the ASES score, the Simple Shoulder Test and a VAS pain scale. The authors report no statistically significant differences between groups with regards to each of these outcomes although the AAOS work group re-calculated the statistics and found workers’ compensation patients had significantly worse SST and VAS pain scores than those not receiving a claim. The last study95 prospectively evaluated 24 patients (12 receiving workers’ compensation) at an average of 3 years postoperative from an open acromioplasty for rotator cuff tendonitis with UCLA scores. At final evaluation, workers’ compensation patients had significantly worse improvements in pain compared to those not receiving Workers’ compensation.
Based upon the above data, shoulder function as evaluated by the UCLA score, the Simple Shoulder Test and VAS pain scores were all inferior in workers’ compensation patients treated surgically for acromioplasty for rotator cuff tendonitis or rotator repairs compared to a non-workers’ compensation group. This data supports the option of advising patients that workers’ compensation status correlates with less favorable outcomes after rotator cuff surgery.
- (47) Shen PH, Lien SB, Shen HC, Lee CH, Wu SS, Lin LC. Long-term functional outcomes after repair of rotator cuff tears correlated with atrophy of the supraspinatus muscles on magnetic resonance images. J Shoulder Elbow Surg 2008;17(1 Suppl):1S-7S.
- (48) Gladstone JN, Bishop JY, Lo IK, Flatow EL. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 2007;35(5):719-728.
- (49) Gerber C, Schneeberger AG, Hoppeler H, Meyer DC. Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: a study in thirteen patients. J Shoulder Elbow Surg 2007;16(6):691-696.
- (50) Mellado JM, Calmet J, Olona M et al. Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings. AJR Am J Roentgenol 2005;184(5):1456-1463.
- (51) Liem D, Lichtenberg S, Magosch P, Habermeyer P. Magnetic resonance imaging of arthroscopic supraspinatus tendon repair. J Bone Joint Surg Am 2007;89(8):1770-1776.
- (52) Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F. Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res 1997;(344):275-283.
- (54) Goldberg BA, Nowinski RJ, Matsen FA, III. Outcome of nonoperative management of full-thickness rotator cuff tears. Clin Orthop Relat Res 2001;(382):99-107.
- (72) Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 2007;89(6):1184-1193.
- (73) Namdari S, Henn F, Green A. Traumatic anterosuperior rotator cuff tears: The outcome of open surgical repair. J Bone Joint Surg Am 2008;90(9):1906-1913.
- (74) Van Riet RP, O'Leary ST, Hooper A, Bell SN. Rotator cuff strength following open subscapularis tendon repair. Acta Orthop Belg 2008;74(2):173-179.
- (75) Lam F, Mok D. Open repair of massive rotator cuff tears in patients aged sixty-five years or over: is it worthwhile? J Shoulder Elbow Surg 2004;13(5):517-521.
- (76) Prasad N, Odumala A, Elias F, Jenkins T. Outcome of open rotator cuff repair. An analysis of risk factors. Acta Orthop Belg 2005;71(6):662-666.
- (77) Lichtenberg S, Liem D, Magosch P, Habermeyer P. Influence of tendon healing after arthroscopic rotator cuff repair on clinical outcome using single-row Mason-Allen suture technique: a prospective, MRI controlled study. Knee Surg Sports Traumatol Arthrosc 2006;14(11):1200-1206.
- (78) Bhattacharyya T, Yeon H, Harris MB. The medical-legal aspects of informed consent in orthopaedic surgery. J Bone Jt Surg Ser A 2005;87(11):2395-2400.
- (79) Cole BJ, McCarty LP, III, Kang RW, Alford W, Lewis PB, Hayden JK. Arthroscopic rotator cuff repair: prospective functional outcome and repair integrity at minimum 2-year follow-up. J Shoulder Elbow Surg 2007;16(5):579-585.
- (80) DeFranco MJ, Bershadsky B, Ciccone J, Yum JK, Iannotti JP. Functional outcome of arthroscopic rotator cuff repairs: a correlation of anatomic and clinical results. J Shoulder Elbow Surg 2007;16(6):759-765.
- (81) Milano G, Grasso A, Salvatore M, Zarelli D, Deriu L, Fabbriciani C. Arthroscopic rotator cuff repair with and without subacromial decompression: a prospective randomized study. Arthroscopy 2007;23(1):81-88.
- (82) Hattrup SJ. Rotator cuff repair: relevance of patient age. J Shoulder Elbow Surg 1995;4(2):95-100.
- (83) Boehm TD, Werner A, Radtke S, Mueller T, Kirschner S, Gohlke F. The effect of suture materials and techniques on the outcome of repair of the rotator cuff: a prospective, randomised study. J Bone Joint Surg Br 2005;87(6):819-823.
- (84) Murray J, Lajtai G, Mileski RM, Snyder SJ. Arthroscopic repair of medium to large full-thickness rotator cuff tears: Outcome at 2- to 6-year follow-up. J Shoulder Elbow Surg 2002;11(1):19-24.
- (85) Rebuzzi E, Coletti N, Schiavetti S, Giusto F. Arthroscopic rotator cuff repair in patients older than 60 years. Arthroscopy 2005;21(1):48-54.
- (86) Pai VS, Lawson DA. Rotator cuff repair in a district hospital setting: outcomes and analysis of prognostic factors. J Shoulder Elbow Surg 2001;10(3):236-241.
- (87) McKee MD, Yoo DJ. The effect of surgery for rotator cuff disease on general health status. Results of a prospective trial. J Bone Joint Surg Am 2000;82-A(7):970-979.
- (88) Worland RL, Arredondo J, Angles F, Lopez-Jimenez F. Repair of massive rotator cuff tears in patients older than 70 years. J Shoulder Elbow Surg 1999;8(1):26-30.
- (89) Gartsman GM, Khan M, Hammerman SM. Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg Am 1998;80(6):832-840.
- (90) 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(9):1346-1355.
- (91) Gazielly DF, Gleyze P, Montagnon C. Functional and anatomical results after rotator cuff repair. Clin Orthop Relat Res 1994;(304):43-53.
- (92) Lahteenmaki HE, Hiltunen A, Virolainen P, Nelimarkka O. Repair of full-thickness rotator cuff tears is recommended regardless of tear size and age: a retrospective study of 218 patients. J Shoulder Elbow Surg 2007;16(5):586-590.
- (93) Motycka T, Kriegleder B, Landsiedl F. Results of open repair of the rotator cuff--a long-term review of 79 shoulders. Arch Orthop Trauma Surg 2001;121(3):148-151.
- (94) Nicholson GP. Arthroscopic acromioplasty: a comparison between workers' compensation and non-workers' compensation populations. J Bone Joint Surg Am 2003;85-A(4):682-689.
- (95) Lopez JG, Ernst MD, Wright TW. Acromioplasty: comparison of outcome in patients with and without workers' compensation. J South Orthop Assoc 2000;9(4):262-266.
- (96) Misamore GW, Ziegler DW, Rushton JL. Repair of the rotator cuff. A comparison of results in two populations of patients. J Bone Joint Surg Am 1995;77(9):1335-1339.
- (97) Chen AL, Shapiro JA, Ahn AK, Zuckerman JD, Cuomo F. Rotator cuff repair in patients with type I diabetes mellitus. J Shoulder Elbow Surg 2003;12(5):416-421.
- (98) Hsu SL, Ko JY, Chen SH, Wu RW, Chou WY, Wang CJ. Surgical results in rotator cuff tears with shoulder stiffness. J Formos Med Assoc 2007;106(6):452-461.