Predictors of Return to Work Following Primary Arthroscopic Rotator Cuff Repair: An Analysis of 1502 Cases

Abstract

Background: It is undetermined which factors predict return to work after arthroscopic rotator cuff repair. Purpose: To identify which factors predicted return to work at any level and return to preinjury levels of work 6 months after arthroscopic rotator cuff repair. Study Design: Case-control study; Level of evidence, 3. Methods: Multiple logistic regression analysis of prospectively collected descriptive, preinjury, preoperative, and intraoperative data from 1502 consecutive primary arthroscopic rotator cuff repairs, performed by a single surgeon, was performed to identify independent predictors of return to work at 6 months postoperatively. Results: Six months after arthroscopic rotator cuff repair, 76% of patients had returned to work, and 40% had returned to preinjury levels of work. Return to work at 6 months was likely if patients were still working after their injuries but before surgery (Wald statistic [W] = 55, P < .0001), were stronger in internal rotation preoperatively (W = 8, P = .004), had full-thickness tears (W = 9, P = .002), and were female (W = 5, P = .030). Patients who continued working postinjury but presurgery were 1.6 times more likely to return to work at any level at 6 months compared to patients who were not working ( P < .0001). Patients who had a less strenuous preinjury level of work (W = 173, P < .0001), worked at a mild to moderate level post injury but presurgery, had greater preoperative behind-the-back lift-off strength (W = 8, P = .004), and had less preoperative passive external rotation range of motion (W = 5, P = .034) were more likely to return to preinjury levels of work at 6 months postoperatively. Specifically, patients who worked at a mild to moderate level postinjury but presurgery were 2.5 times more likely to return to work than patients who were not working, or who were working strenuously postinjury but presurgery ( p < 0.0001). Patients who nominated their preinjury level of work as “light” were 11 times more likely to return to preinjury levels of work at 6 months compared to those who nominated it as “strenuous” ( P < .0001). Conclusion: Six months after rotator cuff repair, patients who continued to work after injury but presurgery were the most likely to return to work at any level, and patients who had less strenuous preinjury levels of work were the most likely to return to their preinjury levels of work. Greater preoperative subscapularis strength independently predicted return to work at any level and to preinjury levels.

A Systematic Temporal Assessment of Changes in Tendon Stiffness Following Rotator Cuff Repair

“…with 25 years of experience in shoulder ultrasound, using previously validated protocols. 13,19,31 The sonographic assessment comprised of conventional B-mode (greyscale) ultrasound to determine the integrity of the repair, and shear wave elastography to assess the stiffness (m/s) of the repaired supraspinatus tendon using the VTIQ (Virtual Touch™IQ, Siemens ACUSON S3000 HELIX Evolution ultrasound system, Siemens Medical Solutions, Mountain View, CA) with a 9 L4 linear transducer. The range of shear wave elastography values detectable with this equipment range from 0.5 m/s to 10 m/s.…”

Revision Rotator Cuff Repair With Versus Without an Arthroscopically Inserted Onlay Bioinductive Implant in Workers’ Compensation Patients

“…Passive shoulder range of motion (ROM) in forward flexion, abduction, external rotation, and internal rotation, respectively, and shoulder strength in abduction, adduction, internal rotation, external rotation, and liftoff from behind the back were measured using a handheld dynamometer (HFG 110; Transducer Techniques) preoperatively and at 6 weeks, 3 months, and 6 months postoperatively. 6,11,16,20 Ultrasound Assessment All assessments of rotator cuff repair integrity and SWE stiffness of the supraspinatus tendon were performed on an ultrasound system with virtual touch imaging quantification elastography (Siemens Acuson S3000 HELIX Evolution ultrasound system with Virtual Touch IQ; Siemens Medical Solutions) with a linear 9L4 MHz transducer, per previously validated protocols. 4,9,21 A single sonographer (L.H.)…”

Predictive factors of return‐to‐work trajectory after work‐related rotator cuff syndrome: A prospective study of 96 workers

“…On the contrary, Ting et al 26 confirm that patients who performed less strenuous work before their injury are the most likely to resume their previous responsibilities. 26 Individually, the failure of the process is directly linked to the functional result of the operated shoulder in 16% of cases. 17 According to Collin et al, 10 an operated tendon that has failed to heal is associated with the inability for workers involved in heavy manual labor to return to work.…”

“…17 Gutman et al 19 confirmed that patients with three tendon tear repairs experience the worst functional outcomes. Ting et al, 26 for their part, conclude that patients who continue to work after suffering an injury but before undergoing surgery are the most likely to return to work. 26 Creton 22 mentions time off work before surgery and complications after surgery, such as complex regional pain syndrome or capsulitis, as factors that prolong the duration of sick leave.…”

“…Ting et al, 26 for their part, conclude that patients who continue to work after suffering an injury but before undergoing surgery are the most likely to return to work. 26 Creton 22 mentions time off work before surgery and complications after surgery, such as complex regional pain syndrome or capsulitis, as factors that prolong the duration of sick leave. Pichené-Houard et al 28 cite time off work before surgery, the number of areas in the body causing pain or discomfort in the last 12 months, and a high level of physical demand in the job as preoperative factors for prolonging the duration of sick leave after surgery.…”