Summary

Rotator cuff repairs in patients with pre-existing glenohumeral osteoarthritis have similar clinical and functional outcomes as repairs in patients without osteoarthritis with the exception of a slightly decreased postoperative FF and ER ROM.

Abstract

Introduction

Glenohumeral osteoarthritis is a common comorbidity in patients with rotator cuff tears. Management of rotator cuff tears in patients with concomitant glenohumeral osteoarthritis is varied and still heavily debated. Although rotator cuff repairs have been shown to have excellent long-term outcomes in the general population, very few studies have demonstrated their efficacy in patients with preexisting glenohumeral osteoarthritis. Thus, the purpose of this study is to compare the clinical and functional outcome measures following arthroscopic rotator cuff repairs in patients with preexisting glenohumeral osteoarthritis to those without. We hypothesized that failures rates as well as objective and patient reported outcomes would be similar between the two groups.

Methods

A retrospective review of 206 consecutive patients who underwent arthroscopic supraspinatus repairs (both isolated and with accompanying infraspinatus/subscapularis involvement) between 2013-2018 with a minimum of one-year follow up was performed. Patients were separated into two groups based on presence or absence of preexisting glenohumeral osteoarthritis. The groups were controlled for tear pattern, sex, BMI, tobacco/alcohol use, and common co-morbidities. The primary outcome was failure of repair, defined as need for revision repair or a re-tear confirmed on postoperative MRI. Secondary outcomes were patient-reported outcome measures (PROs) including visual analog pain scale (VAS), subjective shoulder value (SSV), and American Shoulder and Elbow Surgeons (ASES) score; active range of motion (ROM), including forward flexion (FF), external rotation (ER), and internal rotation (IR); and strength testing, including FF, ER, and IR. Within the osteoarthritis cohort, a subgroup analysis was conducted to compare outcomes between mild versus moderate to severe osteoarthritis. Outcomes were compared using Mann-Whitney U and Fisher’s Exact Test with p<0.05.

Results

There were 91 patients in the glenohumeral osteoarthritis group and 115 patients in the control group. There was a significant difference in the postoperative FF (153.55 ± 21.07 vs. 160.14 ± 17.26 degrees, p=0.001) and ER (46.91 ± 11.95 vs. 52.25 ± 11.60 degrees, p=0.001) ROM between the glenohumeral osteoarthritis and control groups, respectively. There were no significant differences between groups for revisions repairs, retears, postoperative IR ROM, all preoperative ROM, all PROs, and all strength parameters (all p > 0.05).

For the subgroup analysis, there were 70 patients in the mild osteoarthritis group and 21 patients in the moderate to severe osteoarthritis group. There was a significant difference in the postoperative FF strength (88.4% vs. 61.9% with 5/5 strength, p=0.010) and ER strength (89.9% vs. 71.4% with 5/5 strength, p=0.046) between the mild and moderate to severe groups, respectively. There were no significant differences between the groups for all other outcome measures.

Discussion

Rotator cuff repair remains an excellent treatment in patients with pre-existing glenohumeral osteoarthritis. The data from this study demonstrates that rotator cuff repairs in patients with pre-existing glenohumeral osteoarthritis have similar clinical and functional outcomes as repairs in patients without osteoarthritis with the exception of a slightly decreased postoperative FF and ER ROM. Patients with moderate to severe osteoarthritis may have slightly decreased FF and ER strength outcomes compared to those with mild osteoarthritis.