Purpose: Few studies have investigated the relationship between patients requiring rotator cuff surgery and their body mass index (BMI). The objective of this retrospective study was to evaluate the association between BMI and pre-operative pain and function in patients awaiting rotator cuff repair surgery as measured by the American Shoulder and Elbow Surgery (ASES) form and Simple Shoulder Score (SST). A second objective was to evaluate the role of several other factors in predicting patient pre-operative scores.

Method: Patients selected for this study were those who underwent arthroscopic rotator cuff repair performed by the same surgeon between 2002 and 2007. Their medical record included documentation of age, height, weight, smoking status, worker’s compensation status (WCB), and pre-operative ASES and SST scores. Correlation between BMI and ASES and SST scores was performed to determine the association between these variables. In addition, multiple stepwise regression was performed to assess the predictive value of other demographic and lifestyle factors.

Results: Fifty-four patients were included in the study (39 men, 15 women). No significant correlation was found between BMI and either ASES or SST scores. Based on multiple regression analysis, only WCB status was identified as a significant predictor of pre-operative ASES score (p=0.003) while sex, age, BMI, and smoking status were not. Patients with WCB claims had lower ASES scores than those without. Sex was found to have the strongest association with SST scores (r2 = 0.502) with men having greater SST scores than women. The model with the most significant value in predicting SST scores included sex, WCB and smoking status (r2 -= 0.640). Patients that did not fall under a WCB claim and were non-smokers had better SST scores pre-operatively.

Conclusion: BMI did not have a significant relationship to ASES and SST scores in patients awaiting rotator cuff repair surgery. A prospective study including pre- and post-surgical follow-up and a detailed analysis of the role between BMI and other demographic and lifestyle factors would be beneficial. Such a risk factor analysis may shed light on the indications for rotator cuff surgery or non-operative management, depending on the patient population.

Purpose: The diagnosis and treatment of superior labral antero posterior (SLAP) lesions is a controversial subject in shoulder pathology. The aim of this retrospective study was to evaluate the strength of association between clinical assessment (O’Brien test), standard MRI, and arthroscopic identification of a SLAP lesion.

Method: Patients who underwent isolated arthroscopic treatment of a SLAP lesion by two senior orthopaedic surgeons between 2004 and 2007 were included in this study. Pre-operatively, all had a standard MRI and the outcome of O’Brien test had been documented. Sensitivity of these measures in detecting a SLAP lesion confirmed through arthroscopy were calculated independently and combined. The relationship between O’Brien test and standard MRI are also presented.

Results: Forty-five patients were included in this study. The O’Brien test demonstrated a sensitivity of 42% (true positive) in detecting a SLAP lesion while sensitivity of the standard MRI was only 13%. The sensitivity of the O’Brien test and standard MRI when considered together was 47%, only slightly higher than the O’Brien test alone. The association between the O’Brien test and standard MRI in identifying a SLAP lesion as measured by the phi correlation coefficient was −0.19 which suggests little to no relationship (p = 0.095).

Conclusion: The current study illustrates the difficulties in accurately diagnosing a SLAP lesion pre-operatively. Previously documented sensitivity of the O’Brien test in identifying a SLAP lesion was not replicated herein. Furthermore, this study draws into question the practice of patient’s undergoing a standard MRI for SLAP lesion identification because the added value from this investigation was nominal. A standard MRI is often requested when the diagnosis is not certain or to exclude other shoulder pathology. If, however, a SLAP lesion is suspected clinically in absence of other shoulder pathology, then a diagnostic tool other than standard MRI may be more meaningful. Some literature suggests MRI arthrogram may be useful in diagnosing a SLAP lesion but access to this tool can be limited.

The purpose of this prospective randomised clinical trial is to examine the effect of acromioplasty on the outcome of arthroscopic rotator cuff repair.

Patients included individuals that were referred for assessment after six months of failed conservative management. Following informed consent patients were randomly assigned to receive arthroscopic rotator cuff repair with or without acromioplasty. The surgeon was not blinded to the type of procedure; however, the researcher who performed the follow-up evaluations and the patient was blinded to the surgical protocol. Subacromial decompression (acromioplasty) was performed with release of the coracoacromial ligament off the anterior undersurface of the acromion. The procedure for arthroscopic cuff repair without acromioplasty followed the protocol of arthroscopic cuff repair with acromioplasty, without division of the coracoacromial ligament or resection of the acromion. Both groups experienced the same post-operative rehabilitation protocol. Wound healing and active and passive range of motion were assessed and recorded at six to eight weeks post-operatively. Subsequent post-operative visits occurred at three, six, twelve, eighteen and twenty-four months and included documentation of patient range of motion, patient derived WORC scores (1) and complete ASES scores.

Preliminary results suggest, based on a one-tailed t-test, patients that receive a rotator cuff repair with acromioplasty demonstrate a statistically significant improvement (< 0.05) in Quality of Life, based on WORC and ASES scores, compared to the non-acromioplasty group. To date, three patients in the non-acromioplasty group required a revision surgery; two of these patients had a Type III acromion.

Arthroscopic rotator cuff repair with arthroscopic acromioplasty in the treatment of full thickness rotator cuff tears is recommended for patients with a Type III acromion.