Re-tear following rotator cuff repair: Do functional outcomes predict success?

Abstract

Purpose

The purpose of this study is to compare functional outcomes between patients who were found to have a retear on ultrasound versus those with an intact repair following arthroscopic rotator cuff repair.

Methods

Retrospective cohort study comparing functional outcomes of 84 patients who underwent arthroscopic rotator cuff repair and were found to have a retear versus those who did not experience a retear. Functional outcomes included American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test, strength and active range of motion (AROM) assessed preoperatively and postoperatively at 3 and 6 months.

Results

Patients without a retear by 6 months demonstrated greater improvements in internal rotation at 3 months (2.3° of mean change, p = 0.0356), as well as greater improvements in external rotation range of motion (8.8° of mean change, p = 0.0210) between 3 and 6 months as compared to those patients who did experience a retear. Both groups showed decreased pain scores and increased ASES scores at all points postoperatively.

Conclusions

Our study found statistically significant improvements in internal rotation at 3 months, and external rotation between 3 and 6 months in the non-retear group. No differences in functional outcomes existed between at final follow-up.

Introduction

Rotator cuff tears (RCTs) are relatively common injuries, found in approximately 20% of 60-year-olds, 31% of 70-year-olds, and 51% of 80-year-olds. ¹ About two-thirds of RCTs are asymptomatic. However, if symptomatic, they can dramatically affect a patient's quality of life.^2,3 Signs and symptoms associated with RCT include a positive impingement sign, shoulder weakness, and decreased range of motion. ³ Treatment options include both conservative and surgical measures. Surgical debridement and repair are reserved for high-grade partial tears refractory to conservative treatment and complete rotator cuff tendon tears.^4,5 An estimated 200,000–300,000 rotator cuff injuries are surgically repaired in the United States each year, with repair rates linearly increasing since 1995.^5,6 As the total number of RCTs surgically repaired increases, the incidence of retears following a repair has also increased. Risk factors associated with rotator cuff retears include increased age, diabetes, smoking, preoperative fatty infiltration, muscle atrophy, and preoperative tear size.^7–13 Postoperative rehabilitation protocols and surgical techniques can also affect retear rates. ¹⁴ Rotator cuff repairs following a retear demonstrate lower success rates and decreased patient satisfaction. ¹⁵

Although many studies have investigated rates of rotator cuff retear after surgical repair, the functional outcomes following a retear are less explored in the literature. Intact rotator cuff repairs appear to lead to better functional outcomes and strength when compared to rotator cuff retears.,^16,17 but some studies suggest that full healing of rotator cuff tendons may not be necessary for pain relief and clinical improvement.^18,19 The primary aim of this study was to perform a consecutive patient series of patients undergoing primary arthroscopic rotator cuff repair in which repair integrity was evaluated at 6 months, and compare the functional outcomes of those patients who were found to have an intact repair versus those patients who were found to have a retear. We theorized that individuals who experience a retear following arthroscopic repair will have inferior functional outcomes compared to their counterparts who did not develop a retear. This study utilized a consecutive patient series comparing functional outcomes of patients who underwent arthroscopic rotator cuff repair and who were routinely evaluated for repair integrity at 6 months.

Methods

Approval for this retrospective cohort study was granted by the Institutional Review Board at our institution. All data were collected prospectively and analyzed retrospectively. Inclusion criteria included a full- or high-grade partial-thickness RCT as defined by the Ellman Classification as a grade 2 or 3 involving the supraspinatus and infraspinatus, age less than 65 years, and a willingness to complete physical therapy. Exclusion criteria included revision surgery, irreparable tears, a history of rheumatoid arthritis, unwillingness to complete physical therapy, and an inability to understand the study consent form.

Eighty-four patients met the inclusion criteria for the study between June 2018 and July 2019. Patient demographics collected included age at surgery, tobacco use, workers’ compensation status, tear laterality, hand dominance, size of the tear, and acute versus chronic status of the tear. This study defined a chronic tear as any tear which existed for more than 6 months from the onset of pain, whereas any injury that occurred within 6 months was defined as an acute tear. Other data collected included surgical methods at the time of the repair, including acromioplasty, biceps tenotomy or tenodesis, and the number of medial row anchors used. Rotator cuff integrity was assessed routinely for all patients via ultrasound at the 6-month postoperative check. All ultrasounds were performed and read by a fellowship-trained musculoskeletal radiologist. Patients were assigned to comparative groups based on the presence of a retear seen on ultrasound.

Preoperatively, patients underwent an initial evaluation which included a Visual Analog Pain (VAS) Score,^20,21 American Shoulder and Elbow Surgeons (ASES) Score,^22,23 Simple Shoulder Test (SST) ²³ and strength and active range of motion (AROM) assessments. Muscle strength and AROM were measured by a hand-held force gauge and goniometer in forward flexion (FF), external rotation (ER), abduction (ABD), and internal rotation (IR). These measurements and tests were performed again at 3- and 6-month follow-up visits. All measurements were obtained by a blinded physical therapy technician independent of the measurements from the surgeon using objectively measured data to reduce intraobserver bias.

Data analysis

This was a retrospective cohort study using prospectively collected data comparing functional outcomes of patients who underwent arthroscopic rotator cuff repair and were found to have a retear versus those who did not experience a retear. The primary investigative metric was functional outcomes between the two groups. The analysis included preoperative assessments and follow-up assessments at 3 and 6 months. Patient characteristics were evaluated to ensure there were no significant differences between the two groups in terms of demographics or risk factors. Descriptive statistics included reporting the numerical data as means with standard deviation and range, and median and interquartile range for abnormal distribution. The categorical variables were reported as number and percentage. The categorical variables were compared between the groups with the use of Fisher's exact test or the chi-square test as appropriate. Continuous variables were compared between the two groups with the use of Student's t-test or Wilcoxon rank-sum test as appropriate. A p-value <0.05 was considered to be statistically significant. All statistical analyses were done with the use of SAS software, version 9.4 (SAS Institute Inc., Cary, NC, USA).

Surgical technique

Patients were placed in the beach-chair position and prepped and draped in a standard sterile fashion. A diagnostic shoulder arthroscopy was performed and pathology was assessed. Although supraspinatus and infraspinatus were the primary targets of this study any subscapularis tear identified intra-op (4 in the Intact group, and 6 in the Retear group) was treated with either debridement or repair as appropriate. The long head of the biceps was assessed and treated with a tenotomy or tenodesis if there were tears or subluxation present. The rotator cuff was assessed with a grasper and a probe to determine repairability and the size of the tear. The rotator cuff was debrided and the footprint was prepared with an arthroscopic shaver. Care was taken to ensure that the shaver would abrade the bony surface of the footprint without removing substantial cortical bone. The rotator cuff tendon was then repaired to the footprint using a standard double-row technique. A single double-loaded medial row anchor was used in tears with an anterior-to-posterior distance of 20 mm or less. For tears greater than 20 mm, a second double-loaded medial row anchor was used. For lateral row fixation, all patients received a PEEK anchor. Two lateral row anchors were used for tears 20 mm or smaller, and three lateral row anchors were used for larger tears. An acromioplasty was not routinely done, but was performed arthroscopically if required due to prominent spurring as determined by the performing surgeon. Partial thickness tears were fixed with completion of the tear followed by repair with one medial row anchor and two lateral row anchors using a standard double-row technique.

Rehabilitation

All patients remained non-weight-bearing in a shoulder immobilizer with an ABD pillow until the 6-week follow-up appointment. At the initiation of physical therapy at 6 weeks postoperatively, patients were given a standard protocol to take to their physical therapy appointment. This included initiation of shoulder mobilization including pendulums, passive range of motion from weeks 6 to 12, and finally, a supervised strengthening program.

Results

Of the 84 patients who underwent arthroscopic rotator cuff repair, 19 (22.6%) were found to have a retear on ultrasound at their 6-month postoperative check, and 65 (77.4%) were found to have no retear. Prior to intervention, patient demographics and preoperative scores were found to have no statistically significant differences between the retear and non-retear groups (Table 1). Additional intraoperative procedures or a number of medial row anchors used were also not significantly different between groups. The medial to lateral size of the initial tear was the only preoperative factor to have any statistical significance on postoperative rate of retear, with a median preoperative tear size measured medially to laterally of 15 mm (range 8–21 mm) in the retear group versus 10 mm (range 7–15 mm) in the non-tear group (p = 0.0433). No tear size measured anteriorly to posteriorly had any significance in regard to retear rates.

Table 1.

Patient demographics.

	Retear group		Non-retear group		p-Value
Total number of patients	19		65
Age at surgery—median	57		55		0.4036
Tobacco use—no. (%)	3	15.79%	13	20.00%	1.0000
Workman's comp—no. (%)	2	10.53%	14	21.54%	0.5064
Laterality—no. (%)					0.7707
Right	13	68.42%	48	73.85%
Left	6	31.58%	17	26.15%
Hand dominance—no. (%)					0.6365
Left	2	11.76%	5	8.20%
Right	13	76.47%	52	85.25%
Ambi	2	11.76%	4	6.56%
Status					0.4340
Acute	8	42.11%	34	52.31%
Chronic	11	57.89%	31	47.69%
Acromioplasty—no. (%)	0	0.00%	3	4.62%	1.0000
Biceps tenodesis—no. (%)	3	15.79%	4	6.15%
Biceps tenotomy—no. (%)	6	31.58%	26	40.00%
Size of tear A–P (mm)—median, IQR	17	13–25	15	12–22	0.5100
Size of tear M–L (mm)—median, IQR	15	8–21	10	7–15	0.0433
Number of medial row anchors—no. (%)					0.8289
1	13	68.42%	46	70.77%
2	6	31.58%	18	27.69%
3	0	0.00%	1	1.54%

Mean range of motion, strength values, ASES, SST, and VAS pain scores at 3- and 6-month follow-ups were recorded (Tables 2 and 3). Preoperative and follow-up outcome comparisons at both 3 months and 6 months were also analyzed (Tables 2 and 3). In the non-retear group, all patient-reported outcome scores, range of motion measurements, and muscle strength, with the exception of ABD, were significantly improved at 6-month follow-up as compared to their preoperative baseline. In the retear group, patient-reported outcome scores, range of motion in FF and ABD, as well as strength testing in ER and ABD were significantly better at final follow-up (6-month postoperative) as compared to their preoperative baseline.

Table 2.

Outcome comparisons at 3-month follow-up.

	Retear group (n = 19)						Non-retear group (n = 65)						Difference between the two groups	p-Value for the two group comparisons
Outcomes	Preoperative		3-month follow-up		Mean change from preoperative to 3 months	p-Value	Preoperative		3-month follow-up		Mean change from preoperative to 3 months	p-Value
Preop ASES	46.5 (15.4)	10–72	65.8 (12.7)	42–97	19.3	<0.0001	46.8 (18.0)	8–80	59.2 (18.4)	27–100	12.4	<0.0001	6.90	0.0879
Preop Simple Shoulder	5.3 (2.7)	0–9	6.39 (2.4)	2–10	1.1	0.1720	5.3 (3.2)	0–12	5.9 (3.2)	0–12	0.6	0.2934	0.49	0.5767
Preop Pain Score	5 (2.4)	1–9	2.1 (2.0)	0–7	−2.9	<0.0001	4.8 (2.3)	0–9	2.8 (2.1)	0–9	−2.0	<0.0001	0.90	0.1467
Preop FF (degrees)	100.5 (48.4)	16–165	105.2 (36.1)	30–151	4.7	0.7191	121.9 (41.2)	9–177	112.9 (34.5)	0–180	−9.0	0.0862	13.70	0.2476
Preop ER (degrees)	53.7 (21.7)	10–82	55.9 (14.0)	34–83	2.2	0.5323	57.2 (17.0)	14–87	50.5 (18.0)	12–90	−6.7	0.0165	8.90	0.1013
Preop IR (level)	12.9 (4.4)	4–18	14.3 (4.4)	4–18	1.4	0.0929	11.1 (4.4)	3–18	15.0 (3.1)	7–18	3.7	<0.0001	2.30	0.0356
Preop ABD (degrees)	105.6 (46.8)	25–172	106.6 (42.7)	29–162	1.0	0.9377	107.2 (47.2)	17–180	102.6 (39.2)	0–174	−4.6	0.4193	5.60	0.6533
Preop FF strength (N)	63.2 (25.5)	23.5–109	66.5 (25.9)	17.7–106.7	3.3	0.5309	63.6 (36.0)	0–179.7	66.8 (34.1)	0–160.6	3.2	0.4256	0.10	0.9907
Preop ER strength (N)	34.8 (18.3)	0–63.1	35.3 (16.9)	0–65.8	0.5	0.9175	39.9 (23.9)	0–98.3	37.6 (17.0)	0–89.4	−2.3	0.3724	2.80	0.6056
Preop IR strength (N)	58.9 (22.2)	25.8–101.8	53.4 (20.2)	16.4–80.9	−5.5	0.0654	54.8 (26.1)	16.4–116.5	53.7 (21.9)	0–116.5	−1.1	0.6534	4.40	0.2433
Preop ABD strength (N)	33.3 (14.1)	14.6–61.8	32.0 (16.6)	0–66.2	−1.3	0.7186	34.4 (25.0)	0–127.2	32.2 (20.2)	0–110.3	−2.2	0.5107	0.90	0.8568

Table 3.

Outcome comparisons at 6-month follow-up.

	Retear group (n = 19)						Non-retear group (n = 65)						Difference between the two groups	p-Value for the two group comparisons
Outcomes	Preoperative		6-month follow-up		Mean change from preoperative to 3 months	p-Value	Preoperative		6-month follow-up		Mean change from preoperative to 3 months	p-Value
Preop ASES	46.5 (15.4)	10–72	79.9 (12.0)	58–100	33.4	<0.0001	47.1 (18.7)	8–80	80.1 (18.7)	25–100	33.0	<0.0001	0.40	0.9448
Preop Simple Shoulder	5.3 (2.7)	0–9	9 (1.8)	5–12	3.7	<0.0001	5.3 (3.3)	0–12	9.6 (2.9)	0–12	4.3	<0.0001	0.60	0.5138
Preop Pain Score	5 (2.4)	1–9	1.1 (1.3)	0–5	−3.9	<0.0001	4.7 (2.4)	0–9	1.4 (2.0)	0–9	−3.3	<0.0001	0.60	0.4343
Preop FF (degrees)	102.5 (47.8)	16–165	137.8 (21.5)	87–169	35.3	0.0041	120.4 (41.2)	9–177	142.2 (20.9)	99–178	21.8	<0.0001	13.50	0.1852
Preop ER (degrees)	55.3 (22.2)	10–83	58.7 (15.7)	32–85	3.4	0.4401	57.2 (17.5)	14–87	62.6 (16.1)	26–91	5.4	0.0482	2.00	0.8005
Preop IR (level)	13 (4.3)	4–18	13.3 (4.9)	4–18	0.3	0.7971	10.8 (4.4)	3–18	12.9 (4.1)	5–18	2.1	0.0012	1.80	0.1365
Preop ABD (degrees)	108.5 (47.3)	25–172	142.6 (30.3)	89–180	34.1	0.0051	105.5 (47.1)	17–180	138.5 (33.5)	21.8–180	33.0	<0.0001	1.10	0.9297
Preop FF strength (N)	62 (25.4)	23.5–109	72.1 (30.7)	26.6–147.7	10.1	0.2002	64 (36.7)	0–179.7	79.0 (41.7)	19.1–214	15.0	0.0017	4.90	0.5822
Preop ER strength (N)	33.9 (18.3)	0–63.1	46.6 (21.6)	16.4–92.7	12.7	0.0086	40.7 (24.6)	0–98.3	48.5 (23.8)	13.7–121.4	7.8	0.0098	4.90	0.3786
Preop IR strength (N)	56.9 (23.1)	21.7–101.8	62.4 (27.9)	27.1–131.6	5.5	0.2998	54.4 (27.1)	15.5–116.5	62.5 (27.9)	16–165.9	8.0	0.0073	2.50	0.6439
Preop ABD strength (N)	32.3 (14.3)	14.6–61.8	47.7 (20.6)	14.2–82.3	15.4	0.0012	35.3 (25.3)	0–127.2	42.3 (25.2)	0–117.4	7.0	0.0545	8.40	0.1956

Statistically significant differences between study groups included range of motion, specifically improved IR in the non-retear cohort at 3 months (Table 2). There was also a significant difference in improvement in ER between 3 and 6 months in the non-retear group compared to the retear group (Table 4).

Table 4.

Outcome comparisons between 3- and 6-month follow-up.

	Retear group (n = 19)						Non-retear group (n = 65)						Difference between the two groups	p-Value for the two group comparisons
Outcomes	3-month follow-up		6-month follow-up		Mean change from preoperative to 3 months	p-Value	3-month follow-up		6-month follow-up		Mean change from preoperative to 3 months	p-Value
Preop ASES	65.8 (12.7)	42–97	81.8 (11.6)	58–100	16.0	<0.0001	60.1 (18.8)	27–100	80.6 (18.1)	25–100	20.5	<0.0001	4.50	0.2513
Preop Simple Shoulder	6.4 (2.4)	2–10	9.3 (1.9)	5–12	2.9	<0.0001	5.9 (3.3)	0–12	9.7 (2.8)	0–12	3.8	<0.0001	0.90	0.2752
Preop Pain Score	2.1 (2.0)	0–7	1.1 (1.3)	0–5	−1.0	0.0293	2.7 (2.1)	0–9	1.3 (1.7)	0–7	−1.4	<0.0001	0.40	0.5487
Preop FF (degrees)	105.2 (36.1)	30–151	138.9 (21.5)	87–169	33.7	0.0002	114.6 (34.8)	0–180	143.4 (19.8)	99–178	28.8	<0.0001	4.90	0.5389
Preop ER (degrees)	55.9 (14.0)	34–83	59.1 (16.1)	32–85	3.2	0.3895	50.9 (18.5)	12–90	62.9 (15.6)	29–91	12.0	<0.0001	8.80	0.0210
Preop IR (level)	14.3 (4.3)	4–18	13.0 (4.9)	4–18	−1.3	0.0106	14.9 (3.2)	7–18	12.8 (4.2)	5–18	−2.1	<0.0001	0.80	0.2196
Preop ABD (degrees)	106.6 (42.7)	29–162	145.2 (28.8)	89–180	38.6	0.0005	103.5 (38.7)	0–174	139.1 (33.2)	21.8–180	35.6	<0.0001	3.00	0.7533
Preop FF strength (N)	66.5 (25.9)	17.7–106.7	72.5 (31.5)	26.6–147.7	6.0	0.2583	66.1 (35.2)	0–160.6	80.7 (41.4)	19.1–214	14.6	0.0002	8.60	0.2246
Preop ER strength (N)	35.3 (16.9)	0–65.8	47.0 (22.2)	16.4–92.7	11.7	0.0111	38.0 (17.9)	0–89.4	49.3 (23.6)	13.7–121.4	11.3	<0.0001	0.40	0.9462
Preop IR strength (N)	53.4 (20.2)	16.4–80.9	63.1 (28.5)	27.1–131.6	9.7	0.0303	53.9 (23.2)	0–116.5	63.4 (27.6)	16–165.9	9.5	0.0018	0.20	0.9611
Preop ABD strength (N)	32.0 (16.6)	0–66.2	49.1 (20.2)	14.2–82.3	17.1	0.0003	31.7 (21.4)	0–110.3	42.8 (25.2)	0–117.4	11.1	0.0019	6.00	0.3418

The retear group was similar to the non-retear group in mean change from preoperative baseline to final follow-up for FF (35.3° vs. 21.8°, p = 0.1852), ER (3.4° vs. 5.4°, p = 0.8005), IR (0.3 vs. 2.1, p = 0.1365), and ABD (34.1° vs. 33.0°, p = 0.9297). Similarly, there was no difference between the groups (retear vs. non-retear) in mean change for muscle strength in FF (10.1 N vs. 15.0 N, p = 0.5822), ER (12.7 N vs. 7.8 N, p = 0.3786), IR (5.5 N vs. 8.0 N, p = 0.6439), or ABD (15.4 N vs. 7.0 N, p = 0.1956) when compared to their preoperative strength values.

ASES, SST, and VAS pain scores were also compared between treatment groups at 3- and 6-month follow-up appointments (Tables 2 and 3). At the final follow-up, there was no difference between the mean change in the retear group and the non-retear group in ASES (33.4 vs. 33, p = 0.9448), SST (3.7 vs. 4.3, p = 0.5138), or VAS scores (−3.9 vs. −3.3, p = 0.4343) as compared to their preoperative values.

Discussion

The reported rate of rotator cuff retears following primary repair varies widely, with estimates between 13% and 94%. ²⁴ A meta-analysis performed by McElvany et al. found a mean retear rate of 26.6% at a mean of 23.7 months postoperatively, with improved patient-reported outcomes regardless of whether the rotator cuff was intact. ²⁵ A recent meta-analysis reported a retear rate of up to 21% at 6 months postoperative for open and arthroscopic surgical repairs, and 17.3% for just arthroscopic repairs. ¹⁴ Our retrospective cohort study included 84 patients treated arthroscopically, 19 (22.6%) of whom were found to have a retear at 6 months postoperatively. This brings our study population in line with the current literature in regard to all surgical repairs. While much of the current literature focuses on the rates of retears and factors affecting retears, our study specifically addressed the functional outcome differences between individuals who experience a rotator cuff retear versus those who did not experience a retear following a primary repair. Studies have shown that while functional and clinical outcomes are satisfactory following revision repair, they are inferior to a primary repair. ²⁶ Revision techniques include revision cuff repair, superior capsule reconstruction, tendon transfer, and reverse shoulder arthroplasty. ²⁷ Given the overall inferiority of revision repairs patient discussions should focus on overall goals of care when considering revision rotator cuff repair following cuff retear.

Our study found statistically significant improvements in range of motion, muscle strength, and patient-reported outcomes in both groups throughout the postoperative period. Both groups had improvements in ASES, SST, VAS pain scores, ER strength, FF, and ABD range of motion. The non-retear group showed improvements in ER and IR, as well as FF and IR strength. The retear group had a significant improvement in ABD strength at 6-month follow-up, while the non-tear group did not, although the change did approach statistical significance. Pain and ASES were the only metrics found to have statistically significant improvements in both groups across all time periods. While significant improvements were seen within each group, when the differences between groups were compared, there were no significant differences between the study groups at the 6-month postoperative check in any of the metrics studied. This is in contrast to a recent meta-analysis on rotator cuff retears that found patients with retears were found to have improvements in pain, but lower ASES scores. ¹⁷

No differences were found between groups in regards to demographics and the rate of retear except for the size of the initial tear measured medially to laterally. Patients in the retear group were found to have a statistically larger initial tear as compared to those who did not have a retear at 6 months. This is in agreement with prior literature that states larger tears are associated with increased rates of retear.^28,29

Our study demonstrated that patients who experienced a rotator cuff retear following an initial repair demonstrated improved patient-reported outcomes despite the initial repair failure. However, while patient-reported outcomes may improve in the short term, the effects of repair failure in the long run remain to be seen. One study demonstrated that osteoarthritis progression was strongly associated with retear rates despite improved short-term functional improvements. This study also demonstrated that while functional outcomes improved at the 2-year postoperative follow-up, at the final follow-up (5.1–14.2 years) patients demonstrated worsened functional outcomes. ³⁰ This suggests that while rotator cuff repair failures do improve clinically after the original repair, in the long run, they demonstrate worsened arthropathy and functional scores. Given this possibility, further research is needed to determine how clinicians should assess our postoperative success following rotator cuff repair, since patient-reported outcomes cannot accurately determine rates of retears. Further research is required to determine the rate and progression of shoulder arthropathy following a rotator cuff repair failure.

Our study has several limitations. First, our study did not include several prognostic factors that are commonly associated with retears, such as degree of fatty degeneration, and body mass index. Additionally, while our study primarily focused on supraspinatus and infraspinatus tears, subscapularis tears identified intra-op were treated and included in the analysis which may confound variables. Furthermore, while ultrasound was used to evaluate for the presence of a rotator cuff retear it was only used to record tear versus retear as a binary value. There was no qualitative analysis in regards to the size of the retear. Another weakness of our study is the duration of follow-up. Six months of postoperative follow-up was chosen based on a study by Miller et al. that demonstrated 100% of rotator cuff repairs that had a retear were found to have occurred within 6 months of the initial repair, 78% of which occurred at 3 months. ³¹ However, it is possible that while the retears were likely to occur in this period, functional deficits might not present until after 6 months. One study performed in the United Kingdom demonstrated that patients for 2 years following rotator cuff repairs demonstrated functional improvements in passive range of motion after 6 months; however, they were found to be of minimal clinical importance. ³² Long-term follow-up would be required to assess this possibility. And finally, our study inclusion criteria dictated a mandatory postoperative physical therapy routine. While progressive physical therapy is universally endorsed following rotator cuff repair, there is the chance that the physical therapy alone may have contributed to improved patient-reported outcomes. A study from the Journal of Shoulder and Elbow Surgery found that patients with atraumatic RCTs reported improvements in ROM and ASES scores following a trial of physical therapy. ³³ This is further emphasized by the lack of a control group treated exclusively with physical therapy alone which may have accounted for the improvement seen in the retear group.

A few notable strengths of our study included the prospective nature of data collection as well as blinding of physical therapy evaluations, and the objective measure in which strength was assessed. All of the data were collected prospectively and retrospectively analyzed. In terms of patient evaluations at postoperative appointments, the physical therapist performing the examination was blinded to the purpose of data collection. Additionally, the evaluations were performed without the primary surgeon present to avoid any bias. And finally, the strength measurements were carried out using a goniometer to ensure objective measurements.

Conclusion

Our study found statistically significant improvements in IR at 3 months, and ER between 3 and 6 months among patients who were not found to have a rotator cuff retear as compared to those patients who were found to have a retear. However, no differences in terms of strength, range, or motion, as well as ASES, SST, or pain scores were found between the groups 6 months postoperatively. Our data suggest that rotator cuff repair improves short-term function regardless of retear and further investigation should be performed to assess the progression of arthropathy following a retear, and whether routine imaging plays a role given the fact that patient functional and satisfaction scores are not a reliable predictor of retear.