88 – PREDICTING PATIENT OUTCOME OF NON-OPERATIVE TREATMENT FOR A CHRONIC ROTATOR CUFF TEAR

Abstract

Purpose: A major issue in the Canadian health care system are the extensive wait times for consultation with an orthopaedic surgeon. We identified that a high percentage of patients referred to shoulder surgery sub-specialists for chronic full thickness rotator cuff tears had not undergone appropriate non-operative treatment prior to being referred, and ultimately did not require surgery. In an effort to improve the referral process and to optimize patient care, we sought to identify clinical predictors for outcome of non-operative treatment of chronic full-thickness rotator cuff tears. This would allow general practitioners to clearly identify patients who are most likely to fail non-operative treatment and actually require surgical consultation. The primary purpose of this study was to determine if the outcome of non-operative treatment in chronic, symptomatic, full-thickness rotator cuff tears could be predicted based upon presenting clinical characteristics, including: age, dominant extremity involvement, gender, duration of symptoms, onset (acute or chronic), forward elevation range of motion, external rotation strength, size of tear, smoking status, and the Rotator Cuff Quality of Life Questionnaire score (RCQOL).

Method: Fifty patients, between the ages of 40 and 85 years, with a documented full-thickness tear on ultrasound or magnetic resonance imaging (MRI), were recruited prospectively. They underwent a three month home-based program of non-operative treatment under the supervision of an experienced physiotherapist and sport medicine physician. At the conclusion of the three month program, patients were evaluated by an orthopaedic surgeon and were defined as having been successful or as having failed non-operative treatment. Successful patients declined surgical treatment after consulting with the surgeon, whereas failed patients elected to undergo surgery, or, if avoiding surgery for other health or “life” reasons, had not experienced adequate improvement with the non-operative program to have been considered successful. The patient’s baseline clinical characteristics were analyzed using logistic regression to determine which characteristics were predictive of outcome.

Results: Thirty-eight of 50 (76%) of patients were successful with the non-operative program. Univariate analysis showed that a patient’s Rotator Cuff Quality of Life questionnaire score was a significant predictor of outcome of non-operative treatment (p = 0.017). Patients who were successful with non-operative treatment had a mean baseline RCQOL score of 49/100, whereas patients who failed non-operative treatment had a mean baseline RCQOL score of 31/100. The two factors of patient age and dominant extremity involvement also trended toward significance.

Conclusion: Baseline RCQOL score can predict which patients will be successful with non-operative treatment and which patients will fail non-operative treatment for a chronic, full-thickness rotator cuff tear.