Elsevier

Journal of Shoulder and Elbow Surgery

Volume 9, Issue 5, September–October 2000, Pages 373-379
Journal of Shoulder and Elbow Surgery

Original Articles
Two 6-year follow-up studies of large and massive rotator cuff tears: Comparison of outcome measures*,**

https://doi.org/10.1067/mse.2000.108389Get rights and content

Abstract

The purposes of this report are (1) to describe the development of a quality-of-life outcome measure for rotator cuff disease (RC-QOL) and a new simple test of rotator cuff function, the Functional Shoulder Elevation Test (FSET), and (2) to compare these with the SF-36 and the American Shoulder and Elbow Surgeons Assessment (ASESA) in a cohort of 86 patients with surgically treated large and massive rotator cuff tears. The RC-QOL is a 34-item self-administered questionnaire that has demonstrated excellent reliability, face validity, and ability to discriminate between large and massive cuff tears; it has also confirmed the construct of higher correlations with the other shoulder outcome measures than with the SF-36. The FSET is a simple test of rotator cuff function that uses 5% body weight and measurement of pain and discomfort on a 100-point visual analog scale. It was highly correlated with the RC-QOL and ASESA and discriminated between large and massive cuff tears. The study achieved an 82% follow-up at an average of 3.5 years. Large cuff tears had statistically significantly improved outcome scores in comparison with massive cuff tears on these 3 outcome measures. The SF-36, however, was not able to discriminate between tear sizes. The RC-QOL and the FSET are recommended outcome measures for rotator cuff disease. (J Shoulder Elbow Surg 2000;9:373-81.)

Section snippets

Methods

The methods used are described in 2 sections. The first section discusses the methods involved in the development of the RC-QOL and the FSET. The second section describes the follow-up study on the cohort of large and massive rotator cuff tears with comparison of the outcome measures.

Results

The results are reported in 2 sections. The first section presents the results of the development of the RC-QOL and the FSET; the second section presents the results of the follow-up study.

Discussion

There is still controversy as to the optimal treatment of full-thickness rotator cuff tears. Many patients respond favorably to nonoperative therapy.6 However, agreement exists with regard to the difficulty of treating patients with large cuff tears and especially of treating patients with massive cuff tears.3, 4, 9 A plethora of repair techniques has been suggested, most of them focusing on reattaching the torn cuff edge to its origin through use of a variety of methods*

Conclusions

The new RC-QOL and the complementary FSET are excellent outcome measures designed specifically for the evaluation of patients with rotator cuff disease. The RC-QOL is a multidimensional, reliable, and valid outcome measure that is self-administered and, in a format developed recently, computer-based. Patients with massive cuff tears have satisfactory outcomes. However, in this series of patients, massive tears rated significantly poorer in all 3 shoulder-related outcome measures than large cuff

References (44)

  • CR. Constant et al.

    A clinical method of functional assessment of the shoulder

    Clin Orthop

    (1987)
  • C Dierickx et al.

    Massive rotator cuff tears treated by a deltoid muscular inlay flap

    Acta Orthop Belg

    (1994)
  • F Flaunty et al.

    Analysis of subjective knee complaints using visual analogue scales

    Am J Sports Med

    (1991)
  • DF Gazielly et al.

    Functional and anatomical results after rotator cuff repair

    Clin Orthop

    (1994)
  • C Gerber et al.

    Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff

    Clin Orthop

    (1988)
  • WA Grana et al.

    An analysis of rotator cuff repair

    Am J Sports Med

    (1994)
  • N Gschwend et al.

    Long term results of surgical management of rotator cuff rupture

    Orthopade

    (1991)
  • GH Guyatt et al.

    Measuring disease-specific quality of life in clinical trials

    CMAJ

    (1986)
  • DT Harryman et al.

    Repairs of the rotator cuff

    J Bone Joint Surg Am

    (1991)
  • SJ. Hatrup

    Rotator cuff repair: relevance of patient age

    J Shoulder Elbow Surg

    (1995)
  • RH Hawkins et al.

    Non-operative treatment of rotator cuff tears

    Clin Orthop

    (1995)
  • RJ Hawkins et al.

    Surgery for full-thickness rotator cuff tears

    J Bone Joint Surg Am

    (1985)
  • Cited by (117)

    • The responsiveness and validity of the Rotator Cuff Quality of Life (RC-QOL) index in a 2-year follow-up study

      2022, JSES International
      Citation Excerpt :

      While this appears to violate certain guidelines, it is important to note that patient groups that participated at the 2-year time interval were not statistically different in age and sex characteristics as those that participated at baseline. The RC-QOL is an easy-to-administer, economical tool that accurately evaluates quality of life, discriminates between patients based on function, and has predictive properties that can provide insight into which patients will likely be successful with nonoperative treatment programs.3,14 Due to a lack of consensus on appropriate measures of responsiveness, more testing using alternate distribution- and anchor-based analyses is important to further bolster the quality of the RC-QOL.

    View all citing articles on Scopus
    *

    Reprint requests: Robert M. Hollinshead, MD, FRCSC, University of Calgary, Sport Medicine Centre, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.

    **

    J Shoulder Elbow Surg 2000;9:373-81.

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