Comparative evaluation of the measurement properties of various shoulder outcome instruments.

BACKGROUND: Various shoulder outcome instruments have been used despite lack of information on their measurement properties; reliability, responsiveness, and validity; and correlation with health-related quality of life. HYPOTHESIS: Most shoulder outcome instruments have poor correlation with Short Form-36, a general measure of health-related quality of life, and with each other. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: A consecutive group of 285 patients who had undergone shoulder surgery completed several shoulder outcome instruments-Short Form-36; University of California, Los Angeles shoulder score; American Shoulder and Elbow Surgeons shoulder evaluation form; Constant score; Simple Shoulder Test; Western Ontario Shoulder Instability Index; and the rating sheet for Bankart repair (Rowe score)-preoperatively and at 3, 6, 9, and 12 months postoperatively. Internal consistency, standardized response mean, effect size, and Pearson correlation were used to evaluate reliability, responsiveness, and validity. RESULTS: The American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and Western Ontario Shoulder Instability Index displayed good internal consistency. The University of California, Los Angeles shoulder score and American Shoulder and Elbow Surgeons form exhibited good responsiveness, whereas Short Form-36 showed the least responsiveness. Pearson correlation coefficients between the shoulder outcome instruments and Short Form-36 were less than excellent (r < .60). Pearson correlation coefficients between the outcome instruments were generally low except for the Constant score and University of California, Los Angeles shoulder score (r = .673, P < .01). CONCLUSION: There was no single shoulder outcome instrument that was superior to the others in terms of the measurement properties. Most of the tested shoulder outcome instruments did not reflect health-related quality of life well and poorly correlated with each other. This meant that the comparison of a given surgical result with different outcome instruments might be of little practical utility. Further prospective and serial studies should be conducted to develop better shoulder outcome instruments that have significant reliability, responsiveness, validity, and correlation with health-related quality of life. A careful combination of outcome instruments might be necessary to compensate the current evaluation systems.

Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome.

PURPOSE: To analyze the relationship between functional outcomes and postoperative cuff integrity (anatomic outcome), and to reveal the factors affecting outcomes of rotator cuff repair. METHODS: Seventy-eight patients who had undergone repair of full-thickness rotator cuff tear received both computed tomographic arthrography (CTA) and functional evaluation a minimum of 1 year after surgery. The mean follow-up period was 19.6 months (range, 12 to 39 months). Anatomic outcome was evaluated by CTA. Functional outcomes were evaluated by visual analogue scale (VAS) for pain and satisfaction with the operation, Constant score, simple shoulder test (SST), and American Shoulder and Elbow Surgeons (ASES) score. Various clinical and structural factors were included for statistical analysis. RESULTS: All patients displayed significant improvement in all functional evaluations at the final visit. Functional outcome did not correlate with anatomic outcome (P > .05). A few variables did relate to functional outcome: female or old age statistically correlated with the score of SST, and the size of the tear correlated with the ASES score (P < .05). The retear was influenced by age, fatty degeneration of the cuff muscles, and the size of tear. Fatty degeneration of the infraspinatus was the most independent predictor of anatomic outcome on multivariate regression analysis. CONCLUSIONS: Rotator cuff repair brought significant functional improvement. However, the functional outcome did not correlate with the anatomic outcome. The fatty degeneration of the infraspinatus muscle served as an independent predictor of the postoperative integrity of the rotator cuff. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation.

PURPOSE: The purpose of this study was to determine whether moderate preoperative shoulder stiffness affects the clinical outcome of rotator cuff repair, and to evaluate the serial change in range of motion (ROM), functional scores, pain, and satisfaction after rotator cuff repair. METHODS: Rotator cuff repair was performed in 125 consecutive patients (127 shoulders). Thirty patients had concomitant moderate shoulder stiffness at the time of the repair. There were no statistical differences in sex ratio, age, the size and retraction of the tear, or the associated pathologies and repair procedure between the stiffness and nonstiffness groups. Arthroscopic capsular release and manipulation were added to the stiffness group, and the same rehabilitation protocol was applied according to the size of the tear. Clinical outcomes were evaluated using ROM, American Shoulder and Elbow Surgeon (ASES) score, Constant score, Simple Shoulder Test (SST), and short form 36. Pain and postoperative patient satisfaction were measured by a visual analog scale. All clinical parameters were prospectively recorded on the day before surgery, and at 3, 6, and 9 months postoperatively, and at their last follow-up visit. RESULTS: Differences of ROM did not reach statistical significance after 6 months of operation. Other functional outcome instruments showed no statistical difference at any follow-up period. Postoperative cuff integrity after 1 year showed no statistical difference between 2 groups. CONCLUSIONS: This study suggests that moderate preoperative shoulder stiffness does not affect clinical outcomes of rotator cuff repair if arthroscopic capsular release with manipulation is added to the index procedure. Arthroscopic capsular release with manipulation and a well programmed rehabilitation program can avoid any delay of surgery and limitation of motion after cuff repair in patients with concomitant moderate shoulder stiffness. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Trans-rotator cuff portal is safe for arthroscopic superior labral anterior and posterior lesion repair: clinical and radiological analysis of 58 SLAP lesions.

BACKGROUND: There are numerous accessory portals for the arthroscopic repair of superior labral anterior and posterior lesions. Many surgeons are reluctant to make a portal through the cuff because of concern about iatrogenic injury to the cuff. HYPOTHESIS: An arthroscopic superior labral anterior and posterior lesion repair procedure using the trans-rotator cuff portal may yield favorable clinical and radiological outcomes, and cuffs may heal properly. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-eight consecutive patients undergoing superior labral anterior and posterior lesion repair using the trans-rotator cuff portal, who had available both functional and radiological outcomes after 1 year of the operation, were enrolled. We evaluated the structural outcomes for the labrum and cuff using computed tomographic arthrography and measured various clinical outcomes (the supraspinatus power, visual analog scale for pain and satisfaction, American Shoulder and Elbow Surgeons shoulder evaluation form, University of California-Los Angeles shoulder score, Constant score, and Simple Shoulder Test) at the final visit. RESULTS: All functional outcomes were improved significantly (P < .001). On computed tomographic arthrography, labral healing to the bony glenoid was achieved in all patients. Subacromial leakage of contrast media was observed in 3 patients (5.2%) through the muscular portion without any retraction or gap of the tendon. Two of 3 had preoperative cuff pathologic changes, and they were older than 45 years of age. Partial articular cuff tears were observed in 6 patients (10.3%), and 4 had the lesion preoperatively. There were no statistical differences in functional scores according to the presence of preoperative lesion, postoperative leakage, or partial cuff tear. CONCLUSION: The data demonstrate favorable outcomes for arthroscopic superior labral anterior and posterior lesion repair using the trans-rotator cuff portal. We suggest that the trans-rotator cuff portal is an efficient and safe portal for superior labral anterior and posterior lesion repair, although there are some valid concerns of damaging the cuff in patients with a superior labral anterior and posterior lesion with concurrent cuff disorders, as well as in older patients.