Retrospective study of 50 rotator cuff repairs correlating preoperative clinical and radiographic findings with intraoperative tear characteristics and functional outcomes. Follow-up averaged 3.5 years, with results graded on the UCLA Shoulder Rating Scale (maximum 35 points). The study's central question: which preoperative findings predict who will do poorly after repair?
Three numbers from this paper belong in every preoperative rotator cuff conversation: abduction strength grade 3 or less (4x risk), external rotation strength grade 3 or less (7x risk), and active abduction under 100 degrees (9x risk).
When you see a patient with any of these findings, counsel them that functional restoration is uncertain — but pain relief is still highly likely regardless of tear size or how long symptoms have been present.
The acromiohumeral distance on the AP film is a free data point that tells you what you're walking into: 7 mm or less means a bigger tear, a harder repair, and a patient who will likely have less motion and strength afterward even if the surgery goes well.
Don't rely on arthrography to size the tear preoperatively. Single-contrast was right only 1 in 4 times in this series, and double-contrast showed no correlation at all with intraoperative findings. This is why MRI displaced arthrography as the standard preoperative imaging tool for cuff tears.
Finally, revision rotator cuff repair carries a high failure rate (2 of 3 revisions were unsatisfactory here). The best chance at a good outcome is getting the first repair right.
Retrospective study of 50 rotator cuff repairs correlating preoperative clinical and radiographic findings with intraoperative tear characteristics and functional outcomes. Follow-up averaged 3.5 years, with results graded on the UCLA Shoulder Rating Scale (maximum 35 points). The study's central question: which preoperative findings predict who will do poorly after repair?
Three numbers from this paper belong in every preoperative rotator cuff conversation: abduction strength grade 3 or less (4x risk), external rotation strength grade 3 or less (7x risk), and active abduction under 100 degrees (9x risk).
When you see a patient with any of these findings, counsel them that functional restoration is uncertain — but pain relief is still highly likely regardless of tear size or how long symptoms have been present.
The acromiohumeral distance on the AP film is a free data point that tells you what you're walking into: 7 mm or less means a bigger tear, a harder repair, and a patient who will likely have less motion and strength afterward even if the surgery goes well.
Don't rely on arthrography to size the tear preoperatively. Single-contrast was right only 1 in 4 times in this series, and double-contrast showed no correlation at all with intraoperative findings. This is why MRI displaced arthrography as the standard preoperative imaging tool for cuff tears.
Finally, revision rotator cuff repair carries a high failure rate (2 of 3 revisions were unsatisfactory here). The best chance at a good outcome is getting the first repair right.