Obesity negatively affects outcomes following arthroscopic rotator cuff repair at four-year follow-up.

Introduction: The purpose is to evaluate the influence of obesity (BMI 30 to 39.9 kg/m2) on surgical outcomes following arthroscopic rotator cuff repair surgery. Materials and Methods: A retrospective review was performed examining the outcomes of arthroscopic rotator cuff repair in both a normal weight (BMI 18.5 to 24.9 kg/m2) and an obese (BMI 30 to 39.9 kg/m2) patient population, specifically looking at functional outcomes and range of motion. Secondary variables analyzed were surgical time, complications, and medical comorbidities. Results: 52 normal weight patients (mean BMI 23.7 ± 2.1) and 59 obese patients (mean BMI 34.0 ± 2.4) were included. Both groups demonstrated statistically significant improvements in VAS, SANE and ASES scores (P < 0.0001), however there were significantly better outcomes in the normal weight group in VAS (0.56 ± 0.96 vs 1.42 ± 2.22; P = 0.0108), ASES (96.1 ± 5.8 vs 90.6 ± 15.6; P = 0.0192), and internal rotation (9.2 ± 3.0 vs 10.9 ± 2.3; P = 0.0010). Additionally, the obese cohort had more complications, longer surgical times, and a greater comorbid background. Conclusions: Obesity is associated with significantly more comorbid conditions, surgical complications, longer surgical time, and worse patient reported outcomes than normal weight patients undergoing arthroscopic rotator cuff repair.

Outcomes Following Combined Posterior Labral and SLAP Repair in Military Patients Younger Than 35 Years.

BACKGROUND: Members of the military are known to experience disproportionately high rates of both glenohumeral instability and superior labrum anterior-posterior (SLAP) tears when compared with civilian populations. Although the outcomes after simultaneous repair of Bankart and SLAP lesions have been well described, there is a paucity of literature available regarding the operative management of posterior instability with concomitant superior labral pathology. PURPOSE: To compare outcomes of combined arthroscopic posterior labral and SLAP repair with those of isolated posterior labral repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: All consecutive patients younger than 35 years who underwent arthroscopic posterior labral repair from January 2011 to December 2016 with a minimum follow-up of 5 years were identified. From this cohort of eligible patients, all individuals who had undergone combined SLAP and posterior labral repair (SLAP cohort) versus posterior labral repair alone (instability cohort) were then identified. Outcome measures including the visual analog scale score, Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, Rowe instability score, and range of motion were collected pre- and postoperatively and scores were compared between groups. RESULTS: In total, 83 patients met the inclusion criteria for the study. All patients were active-duty military at the time of surgery. The mean follow-up was 93.79 ± 18.06 months in the instability group and 91.24 ± 18.02 months in the SLAP group (P = .5228). Preoperative SANE and ASES scores were significantly worse in the SLAP group. Both groups experienced statistically significant improvements in outcome scores postoperatively (P < .0001 for all), and there were no significant differences in any outcome scores or range of motion between groups. In total, 39 patients in the instability cohort and 37 in the SLAP cohort returned to preinjury levels of work (92.86% vs 90.24%, respectively; P = .7126), and 38 instability patients and 35 SLAP patients returned to preinjury levels of sporting activity (90.48% vs 85.37%, respectively; P = .5195). Two patients in the instability group and 4 patients in the SLAP group were medically discharged from the military (4.76% vs 9.76%; P = .4326), and 2 patients in each cohort had experienced treatment failure at the final follow-up (4.76% vs 4.88%; P > .9999). CONCLUSION: Combined posterior labral and SLAP repair led to statistically and clinically significant increases in outcome scores and high rates of return to active-duty military service that did not differ significantly from the results after isolated posterior labral repair. The results of this study indicate that simultaneous repair is a viable treatment option for the management of combined lesions in active-duty military patients <35 years of age.

Arthroscopic Repair of Traumatic Rotator Cuff Tears in Patients 70 Years and Older.

Background: There continues to be significant debate on how to manage traumatic rotator cuff tears in older patients. Purpose: To evaluate the clinical outcomes of patients ≥70 years who underwent arthroscopic repair of traumatic rotator cuff tears. Study Design: Case series; Level of evidence, 4. Methods: This retrospective review of prospectively collected data examined outcomes after arthroscopic rotator cuff repair in patients aged ≥70 years with traumatic full-thickness rotator cuff tears. The authors compared preoperative and postoperative outcomes, including American Shoulder and Elbow Surgeons (ASES) scores, Single Assessment Numeric Evaluation (SANE) scores, pain visual analog scale (pVAS) scores, and range of motion measures, as well as assessing postoperative complications. Results: A total of 31 patients met the inclusion criteria. The mean patient age at the time of surgery was 73.6 ± 3.3 years (range, 70-82 years), and the mean follow-up was 38.8 months (range, 24-99 months). The most common mechanism of injury was low-energy falls (87%), followed by motor vehicle collisions (13%). From preoperatively to postoperatively, ASES scores improved from 36.5 ± 15.5 to 95.2 ± 7.7, SANE scores improved from 41.13% ± 20.4% to 94% ± 10.26%, and pVAS scores improved from 7.74 ± 2.13 to 0.48 ± 1.03 (P < .0001 for all). A comparison of repairs performed at <6 months versus ≥6 months from injury yielded no statistically significant differences in ASES, SANE, or pVAS scores (P = .930, .445, and .806, respectively) or in forward flexion, external rotation, or internal rotation (P = .328, .063, and .811, respectively) at the final follow-up. Conclusion: Arthroscopic rotator cuff repair for traumatic full-thickness tears in patients aged ≥70 years demonstrated favorable clinical results. Surgery before or after 6 months of injury did not affect outcomes in this cohort. Surgical treatment should be strongly considered for traumatic rotator cuff tears in the elderly population.

Long-term Results of Arthroscopic Repair of Full-Thickness Traumatic Rotator Cuff Tears in Active Duty Military Patients Under the Age of 40 Years.

BACKGROUND: Arthroscopic rotator cuff repair is an effective procedure through which to decrease pain and increase strength, with favorable long-term outcomes demonstrated in older patient populations with full-thickness rotator cuff tears. The long-term outcomes after this procedure in younger, higher-demand patients, however, is not as clearly defined. PURPOSE: To report on the long-term outcomes after arthroscopic rotator cuff repair of traumatic full-thickness rotator cuff tears in active duty military patients under the age of 40 years at the time of surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Preoperative, midterm, and final evaluations were collected, including scores on the visual analog scale for pain, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons shoulder form. A total of 42 patients were screened for inclusion: 3 underwent additional surgical procedures on the operative shoulder and 2 were lost to follow-up, leaving 37 patients with mean follow-up of 104.51 months available for analysis. A subgroup analysis was performed comparing outcomes between patients with Southern California Orthopaedic Institute grade 1 or 2 tears and those with grade 3 or 4 tears. RESULTS: At final follow-up, pain per the visual analog scale decreased to 1.16 from 8.03 (P < .0001); the Single Assessment Numeric Evaluation score increased to 87.32 from 48.24 (P < .0001); and the American Shoulder and Elbow Surgeons score increased to 88.68 from 41.00 (P < .0001). There was no statistically significant difference in outcome scores or range of motion between midterm and final follow-up. Improvement in outcome scores and range of motion at final follow-up did not vary between patients with small and large tears. Of 42 patients, 37 (88.1%) were able to return to full unrestricted active duty and sporting activity, while 5 (11.9%) were medically separated from the military. CONCLUSION: Active duty military patients under the age of 40 years with traumatic full-thickness rotator cuff tears had statistically and clinically significant increases in outcome scores and decreases in pain after arthroscopic rotator cuff repair at long-term follow-up.