Why Do Patients Decide to Have Surgery for Their Symptomatic Rotator Cuff Tear? A Prospective Study

Abstract

Introduction: The purpose of this investigation was to evaluate the patients’ main determining factors in deciding to have surgery for a symptomatic rotator cuff tear and correlate these factors with both surgeon decision-making and short term clinical outcomes. Methods: One hundred and forty-nine patients undergoing arthroscopic rotator cuff repair (ARCR) were enrolled prospectively. Patients received a questionnaire preoperatively to determine why they decided to proceed with surgical repair. Patients were queried to rate each factor with regard to importance in their decision for repair. Surgeons were given a similar Likert Scale and queried on how strongly they would recommend surgery for their patients. Pre-and post-operative shoulder function was assessed using American Shoulder and Elbow Society (ASES) Score. Descriptive statistics were used to evaluate the reasons to proceed with surgery, and these were correlated with outcomes based on ASES scores. Results: The most influential patient reported factors for proceeding with surgical repair were: limited shoulder functionality (81%), surgeon recommendation (80%), and daily chronic pain (77%). Patients improved from 42.6 to 77.0 on the ASES from baseline to 6-months (p<0.001). Fifty-two percent of patients had therapy before surgery and 46% of patients had at least one injection before surgery. When separated by genders, the only significant difference occurred 6-month post-operatively where the males had better functional outcomes 81.4 vs 69.9 (p<0.05). Conclusion: Prior studies have shown that ARCR is best at alleviating pain for full thickness rotator cuff tears and may not be as impactful for improving function. Despite this evidence, the majority of patients undergoing rotator cuff repair in our study did so to improve shoulder functionality. While pain was important to our patient population, it was not the highest rated determining factor. The reason for undergoing ARCR did not significantly affect functional outcome at final follow-up in our study.