Early postoperative repair status after rotator cuff repair cannot be accurately classified using questionnaires of patient function and isokinetic strength evaluation

Jessica Colliver, Allan Wang, Brendan Joss, Jay Ebert, E. Koh, W. Breidahl, Tim Ackland

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    Abstract

    © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Background: This study investigated if patients with an intact tendon repair or partial-thickness retear early after rotator cuff repair display differences in clinical evaluations and whether early tendon healing can be predicted using these assessments. Methods: We prospectively evaluated 60 patients at 16 weeks after arthroscopic supraspinatus repair. Evaluation included the Oxford Shoulder Score, 11-item version of the Disabilities of the Arm, Shoulder and Hand, visual analog scale for pain, 12-item Short Form Health Survey, isokinetic strength, and magnetic resonance imaging (MRI). Independent t tests investigated clinical differences in patients based on the Sugaya MRI rotator cuff classification system (grades 1, 2, or 3). Discriminant analysis determined whether intact repairs (Sugaya grade 1) and partial-thickness retears (Sugaya grades 2 and 3) could be predicted. Results: No differences (P <.05) existed in the clinical or strength measures. Although discriminant analysis revealed the 11-item version of the Disabilities of the Arm, Shoulder and Hand produced a 97% true-positive rate for predicting partial thickness retears, it also produced a 90% false-positive rate whereby it incorrectly predicted a retear in 90% of patients whose repair was intact. The ability to discriminate between groups was enhanced with up to 5 variables entered; however, only 87% of the partial-retear group and 36% of the intact-repair group were correctly classified. Conclusions: No differences in clinical scores existed between patients stratified by the Sugaya MRI classification system at 16 weeks. An intact repair or partial-thickness retear could not be accurately predicted. Our results suggest that correct classification of healing in the early postoperative stages should involve imaging. Level of evidence: Basic Science Study, Validation of Patient Reported Outcome Instruments.
    Original languageEnglish
    Pages (from-to)536-542
    JournalJournal of Shoulder and Elbow Surgery
    Volume25
    Issue number4
    Early online date10 Dec 2015
    DOIs
    Publication statusPublished - Apr 2016

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    Rotator Cuff
    Magnetic Resonance Imaging
    Discriminant Analysis
    Tendons
    Arm
    Hand
    Trustees
    Validation Studies
    Pain Measurement
    Elbow
    Health Surveys
    Surveys and Questionnaires

    Cite this

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    title = "Early postoperative repair status after rotator cuff repair cannot be accurately classified using questionnaires of patient function and isokinetic strength evaluation",
    abstract = "{\circledC} 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Background: This study investigated if patients with an intact tendon repair or partial-thickness retear early after rotator cuff repair display differences in clinical evaluations and whether early tendon healing can be predicted using these assessments. Methods: We prospectively evaluated 60 patients at 16 weeks after arthroscopic supraspinatus repair. Evaluation included the Oxford Shoulder Score, 11-item version of the Disabilities of the Arm, Shoulder and Hand, visual analog scale for pain, 12-item Short Form Health Survey, isokinetic strength, and magnetic resonance imaging (MRI). Independent t tests investigated clinical differences in patients based on the Sugaya MRI rotator cuff classification system (grades 1, 2, or 3). Discriminant analysis determined whether intact repairs (Sugaya grade 1) and partial-thickness retears (Sugaya grades 2 and 3) could be predicted. Results: No differences (P <.05) existed in the clinical or strength measures. Although discriminant analysis revealed the 11-item version of the Disabilities of the Arm, Shoulder and Hand produced a 97{\%} true-positive rate for predicting partial thickness retears, it also produced a 90{\%} false-positive rate whereby it incorrectly predicted a retear in 90{\%} of patients whose repair was intact. The ability to discriminate between groups was enhanced with up to 5 variables entered; however, only 87{\%} of the partial-retear group and 36{\%} of the intact-repair group were correctly classified. Conclusions: No differences in clinical scores existed between patients stratified by the Sugaya MRI classification system at 16 weeks. An intact repair or partial-thickness retear could not be accurately predicted. Our results suggest that correct classification of healing in the early postoperative stages should involve imaging. Level of evidence: Basic Science Study, Validation of Patient Reported Outcome Instruments.",
    author = "Jessica Colliver and Allan Wang and Brendan Joss and Jay Ebert and E. Koh and W. Breidahl and Tim Ackland",
    year = "2016",
    month = "4",
    doi = "10.1016/j.jse.2015.09.019",
    language = "English",
    volume = "25",
    pages = "536--542",
    journal = "Journal of Shoulder and Elbow Surgery",
    issn = "1058-2746",
    publisher = "Mosby International",
    number = "4",

    }

    TY - JOUR

    T1 - Early postoperative repair status after rotator cuff repair cannot be accurately classified using questionnaires of patient function and isokinetic strength evaluation

    AU - Colliver, Jessica

    AU - Wang, Allan

    AU - Joss, Brendan

    AU - Ebert, Jay

    AU - Koh, E.

    AU - Breidahl, W.

    AU - Ackland, Tim

    PY - 2016/4

    Y1 - 2016/4

    N2 - © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Background: This study investigated if patients with an intact tendon repair or partial-thickness retear early after rotator cuff repair display differences in clinical evaluations and whether early tendon healing can be predicted using these assessments. Methods: We prospectively evaluated 60 patients at 16 weeks after arthroscopic supraspinatus repair. Evaluation included the Oxford Shoulder Score, 11-item version of the Disabilities of the Arm, Shoulder and Hand, visual analog scale for pain, 12-item Short Form Health Survey, isokinetic strength, and magnetic resonance imaging (MRI). Independent t tests investigated clinical differences in patients based on the Sugaya MRI rotator cuff classification system (grades 1, 2, or 3). Discriminant analysis determined whether intact repairs (Sugaya grade 1) and partial-thickness retears (Sugaya grades 2 and 3) could be predicted. Results: No differences (P <.05) existed in the clinical or strength measures. Although discriminant analysis revealed the 11-item version of the Disabilities of the Arm, Shoulder and Hand produced a 97% true-positive rate for predicting partial thickness retears, it also produced a 90% false-positive rate whereby it incorrectly predicted a retear in 90% of patients whose repair was intact. The ability to discriminate between groups was enhanced with up to 5 variables entered; however, only 87% of the partial-retear group and 36% of the intact-repair group were correctly classified. Conclusions: No differences in clinical scores existed between patients stratified by the Sugaya MRI classification system at 16 weeks. An intact repair or partial-thickness retear could not be accurately predicted. Our results suggest that correct classification of healing in the early postoperative stages should involve imaging. Level of evidence: Basic Science Study, Validation of Patient Reported Outcome Instruments.

    AB - © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Background: This study investigated if patients with an intact tendon repair or partial-thickness retear early after rotator cuff repair display differences in clinical evaluations and whether early tendon healing can be predicted using these assessments. Methods: We prospectively evaluated 60 patients at 16 weeks after arthroscopic supraspinatus repair. Evaluation included the Oxford Shoulder Score, 11-item version of the Disabilities of the Arm, Shoulder and Hand, visual analog scale for pain, 12-item Short Form Health Survey, isokinetic strength, and magnetic resonance imaging (MRI). Independent t tests investigated clinical differences in patients based on the Sugaya MRI rotator cuff classification system (grades 1, 2, or 3). Discriminant analysis determined whether intact repairs (Sugaya grade 1) and partial-thickness retears (Sugaya grades 2 and 3) could be predicted. Results: No differences (P <.05) existed in the clinical or strength measures. Although discriminant analysis revealed the 11-item version of the Disabilities of the Arm, Shoulder and Hand produced a 97% true-positive rate for predicting partial thickness retears, it also produced a 90% false-positive rate whereby it incorrectly predicted a retear in 90% of patients whose repair was intact. The ability to discriminate between groups was enhanced with up to 5 variables entered; however, only 87% of the partial-retear group and 36% of the intact-repair group were correctly classified. Conclusions: No differences in clinical scores existed between patients stratified by the Sugaya MRI classification system at 16 weeks. An intact repair or partial-thickness retear could not be accurately predicted. Our results suggest that correct classification of healing in the early postoperative stages should involve imaging. Level of evidence: Basic Science Study, Validation of Patient Reported Outcome Instruments.

    U2 - 10.1016/j.jse.2015.09.019

    DO - 10.1016/j.jse.2015.09.019

    M3 - Article

    VL - 25

    SP - 536

    EP - 542

    JO - Journal of Shoulder and Elbow Surgery

    JF - Journal of Shoulder and Elbow Surgery

    SN - 1058-2746

    IS - 4

    ER -