Rothman Institute, Philadelphia, PA, USA.
Rothman Institute, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2023 Jun;32(6S):S92-S98. doi: 10.1016/j.jse.2023.02.014. Epub 2023 Feb 26.
Workers' compensation (WC) patients are susceptible to poorer outcomes following primary rotator cuff repair (RCR). Failure of structural healing can explain some poor results, and outcomes of revision RCR in this population are unknown.
A retrospective review was performed of individuals receiving WC who underwent arthroscopic revision RCR with or without dermal allograft augmentation at a single institution between January 2010 and April 2021. Preoperative magnetic resonance imaging (MRI) scans were assessed for rotator cuff tear characteristics, Sugaya classification, and Goutallier grade. Postoperative imaging was not routinely obtained unless for continued symptoms or reinjury. Primary outcome measures included return-to-work status, reoperation, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numeric Evaluation (SANE) scores.
Twenty-seven shoulders (25 patients) were included. The population was 84% male, with a mean age of 54 years; 67% were manual laborers, 11% sedentary workers, and 22% with a mixed profession. Average follow-up was 35.4 months. Fifteen patients (56%) returned to work at full-duty status. Six (22%) returned to work with permanent restrictions. Six (22%) were unable to return to work in any capacity. Thirty percent of all patients and 35% of manual laborers changed occupation following revision RCR. Mean time to return to work was 6.7 months. Overall, symptomatic rotator cuff retear was found in 13 patients (48%). Reoperation rate after revision RCR was 37% (10 cases). Among patients who did not undergo reoperation, mean ASES scores improved from 37.8 to 69.4 at final follow-up (P < .001). Mean SANE scores only improved marginally from 51.6 to 57.0 (P = .61). No statistically significant correlation was found between preoperative MRI findings and outcome measures.
Workers' compensation patients demonstrated fair improvements in outcome scores after revision RCR. Although some patients are able to return to full duty, nearly half were either unable to return or returned with permanent restrictions. These data are helpful for surgeons when counseling patients about expectations and return to work after revision RCR in this challenging population.
在接受初次肩袖修复（RCR）的工人赔偿（WC）患者中，更容易出现较差的结果。结构愈合失败可以解释一些不良结果，并且在该人群中，翻修 RCR 的结果尚不清楚。
对 2010 年 1 月至 2021 年 4 月在一家机构接受 WC 治疗并接受关节镜下翻修 RCR 治疗的患者进行回顾性分析，其中包括或不包括真皮移植物增强。术前磁共振成像（MRI）扫描评估肩袖撕裂特征、Sugaya 分类和 Goutallier 分级。除非有持续症状或再受伤，否则通常不会获得术后影像学检查。主要结局指标包括重返工作岗位状态、再次手术、美国肩肘外科医师协会（ASES）标准肩部评估表和单项评估数值评估（SANE）评分。
纳入 27 例（25 例患者）。患者人群中 84%为男性，平均年龄 54 岁；67%为体力劳动者，11%为久坐工作者，22%为混合职业。平均随访 35.4 个月。15 例患者（56%）恢复全负荷工作状态。6 例（22%）恢复工作，但有永久性限制。6 例（22%）无法以任何身份重返工作岗位。所有患者中有 30%和体力劳动者中有 35%在翻修 RCR 后改变了职业。重返工作岗位的平均时间为 6.7 个月。总体而言，13 例患者（48%）发现有症状性肩袖再撕裂。翻修 RCR 后的再手术率为 37%（10 例）。在未接受再手术的患者中，平均 ASES 评分从术前的 37.8 提高到最终随访时的 69.4（P<.001）。平均 SANE 评分仅从 51.6 略有提高至 57.0（P=.61）。术前 MRI 检查结果与结局测量之间未发现统计学上的显著相关性。
在接受翻修 RCR 后，工人赔偿患者的结局评分有了明显改善。尽管有些患者能够恢复全负荷工作，但仍有近一半的患者无法恢复或永久性受限。这些数据有助于外科医生在向该人群中接受翻修 RCR 治疗的患者提供咨询时，了解他们对预期结果和重返工作岗位的期望。
