Clinical Orthopaedics and Related Research

, Volume 466, Issue 12, pp 3025–3033 | Cite as

Do Outcomes Differ after Rotator Cuff Repair for Patients Receiving Workers’ Compensation?

  • R. Balyk
  • C. Luciak-Corea
  • D. Otto
  • D. Baysal
  • L. Beaupre
Original Article


Comparisons of outcomes after rotator cuff repair between Worker’s Compensation Board (WCB) recipients and nonrecipients generally do not consider patient, injury, and shoulder characteristics. We compared preoperative differences between WCB recipients and nonrecipients and determined the impact on their 6-month postoperative outcome. We evaluated a prospective cohort of 141 patients with full-thickness rotator cuff tears, 36 of whom (26%) were WCB recipients, preoperatively and 3 and 6 months after rotator cuff repair. Their mean age was 54.0 ± 10.4 years (standard deviation) and 102 (72%) patients were male. Shoulder range of motion, Western Ontario Rotator Cuff (WORC) index, and American Shoulder and Elbow Surgeons’ score were used to evaluate outcomes. We performed regression analyses to control for baseline differences in age, baseline scores, smoking status, symptom duration, injury type, and associated biceps disorder between WCB recipients and nonrecipients. WCB recipients were younger and more likely to smoke, have a traumatic injury, and undergo surgery within 6 months of injury. WCB recipients had lower recovery for all outcomes when these differences were not considered but when differences were accounted for, only 6-month WORC scores were lower in WCB recipients. Clinicians should consider preoperative characteristics before concluding WCB recipients experience less recovery after surgical repair.

Level of Evidence: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.



We thank Dr. A. Senthilselvan, biostatistician, for assistance with the data analysis in this study and critical review of the study methodology.


  1. 1.
    Anderson K, Boothby M, Aschenbrener D, van Holsbeeck M. Outcome and structural integrity after arthroscopic rotator cuff repair using 2 rows of fixation: minimum 2-year follow-up. Am J Sports Med. 2006;34:1899–1905.PubMedCrossRefGoogle Scholar
  2. 2.
    Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994;308:90–97.PubMedGoogle Scholar
  3. 3.
    Baysal D, Balyk R, Otto D, Luciak-Corea C, Beaupre L. Functional outcome and health-related quality of life after surgical repair of full-thickness rotator cuff tear using a mini-open technique. Am J Sports Med. 2005;33:1346–1355.PubMedCrossRefGoogle Scholar
  4. 4.
    Bohannon RW. Manual muscle testing: does it meet the standards of an adequate screening test? Clin Rehabil. 2005;19:662–667.PubMedCrossRefGoogle Scholar
  5. 5.
    Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87:1229–1240.PubMedCrossRefGoogle Scholar
  6. 6.
    Boissonnault WG, Badke MB, Wooden MJ, Ekedahl S, Fly K. Patient outcome following rehabilitation for rotator cuff repair surgery: the impact of selected medical comorbidities. J Orthop Sport Phys Ther. 2007;37:312–319.Google Scholar
  7. 7.
    Clarkson HM. Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength. Philadelphia, PA: Lippincott Williams and Wilkins; 2000.Google Scholar
  8. 8.
    Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM. Surgical repair of chronic rotator cuff tears: a prospective long-term study. J Bone Joint Surg Am. 2001;83:71–77.PubMedGoogle Scholar
  9. 9.
    DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984;66:563–567.PubMedGoogle Scholar
  10. 10.
    Ellman H, Hanker G, Bayer M. Repair of the rotator cuff: end-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68:1136–1144.PubMedGoogle Scholar
  11. 11.
    Fealy S, Kingham TP, Altchek DW. Mini-open rotator cuff repair using a two-row fixation technique: outcomes analysis in patients with small, moderate, and large rotator cuff tears. Arthroscopy. 2002;18:665–670.PubMedGoogle Scholar
  12. 12.
    Feng S, Guo S, Nobuhara K, Hashimoto J, Mimori K. Prognostic indicators for outcome following rotator cuff tear repair. J Orthop Surg (Hong Kong). 2003;11:110–116.Google Scholar
  13. 13.
    Gartsman GM, Khan M, Hammerman SM. Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg Am. 1998;80:832–840.PubMedGoogle Scholar
  14. 14.
    Green SB. How many subjects does it take to do a regression analysis? Multivariate Behav Res. 1991;26:499–510.CrossRefGoogle Scholar
  15. 15.
    Harryman DT 2nd, Hettrich CM, Smith KL, Campbell B, Sidles JA, Matsen FA 3rd. A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status. J Bone Joint Surg Am. 2003;85:690–696.PubMedGoogle Scholar
  16. 16.
    Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA 3rd. Repairs of the rotator cuff: correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991;73:982–989.PubMedGoogle Scholar
  17. 17.
    Hattrup SJ. Rotator cuff repair: relevance of patient age. J Shoulder Elbow Surg. 1995:4:95–100.PubMedCrossRefGoogle Scholar
  18. 18.
    Hawkins RJ, Misamore GW, Hobeika PE. Surgery for full-thickness rotator-cuff tears. J Bone Joint Surg Am. 1985;67:1349–1355.PubMedGoogle Scholar
  19. 19.
    Hayes K, Ginn KA, Walton JR, Szomor ZL, Murrell GA. A randomised clinical trial evaluating the efficacy of physiotherapy after rotator cuff repair. Austral J Physiother. 2004;50:77–83.Google Scholar
  20. 20.
    Henn RF 3rd, Kang L, Tashjian RZ, Green A. Patients’ preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am. 2007;89:1913–1919.PubMedCrossRefGoogle Scholar
  21. 21.
    Herberts P, Kadefors R, Hogfors C, Sigholm G. Shoulder pain and heavy manual labor. Clin Orthop Relat Res. 1984;191:166–178.PubMedGoogle Scholar
  22. 22.
    Iannotti JP, Bernot MP, Kuhlman JR, Kelley MJ, Williams GR. Postoperative assessment of shoulder function: a prospective study of full-thickness rotator cuff tears. J Shoulder Elbow Surg. 1996;5:449–457.PubMedCrossRefGoogle Scholar
  23. 23.
    Kim SH, Ha KI, Park JH, Kang JS, Oh SK, Oh I. Arthroscopic versus mini-open salvage repair of the rotator cuff tear: outcome analysis at 2 to 6 years’ follow-up. Arthroscopy. 2003;19:746–754.PubMedGoogle Scholar
  24. 24.
    Kirkley A, Alvarez C, Griffin S. The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: The Western Ontario Rotator Cuff Index. Clin J Sport Med. 2003;13:84–92.PubMedCrossRefGoogle Scholar
  25. 25.
    Kleinbaum DG, Kupper LL, Muller KE, Nizam A. Applied Regression Analysis and Other Multivariable Methods. 3rd ed. Toronto, Canada: Duxbury Press; 1998.Google Scholar
  26. 26.
    Kocher MS, Horan MP, Briggs KK, Richardson TR, O’Holleran J, Hawkins RJ. Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. J Bone Joint Surg Am. 2005;87:2006–2011.PubMedCrossRefGoogle Scholar
  27. 27.
    Largacha M, Parsons IM, Campbell B, Titelman RM, Smith KL, Matsen F 3rd. Deficits in shoulder function and general health associated with sixteen common shoulder diagnoses: a study of 2674 patients. J Shoulder Elbow Surg. 2006;15:30–39.PubMedCrossRefGoogle Scholar
  28. 28.
    Liu SH, Baker CL. Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff. Arthroscopy. 1994;10:54–60.PubMedGoogle Scholar
  29. 29.
    Mallon WJ, Misamore G, Snead DS, Denton P. The impact of preoperative smoking habits on the results of rotator cuff repair. J Shoulder Elbow Surg. 2004;13:129–132.PubMedCrossRefGoogle Scholar
  30. 30.
    McKee MD, Yoo DJ. The effect of surgery for rotator cuff disease on general health status: results of a prospective trial. J Bone Joint Surg Am. 2000;82:970–979.PubMedCrossRefGoogle Scholar
  31. 31.
    Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11:587–594.PubMedCrossRefGoogle Scholar
  32. 32.
    Misamore GW, Ziegler DW, Rushton JL. Repair of the rotator cuff: a comparison of results in two populations of patients. J Bone Joint Surg Am. 1995;77:1335–1339.PubMedGoogle Scholar
  33. 33.
    Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG. Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res. 2007;455:52–63.PubMedCrossRefGoogle Scholar
  34. 34.
    O’Holleran JD, Kocher MS, Horan MP, Briggs KK, Hawkins RJ. Determinants of patient satisfaction with outcome after rotator cuff surgery. J Bone Joint Surg Am. 2005;87:121–126.PubMedCrossRefGoogle Scholar
  35. 35.
    Roddey TS, Olson SL, Gartsman GM, Hanten WP, Cook KF. A randomized controlled trial comparing 2 instructional approaches to home exercise instruction following arthroscopic full-thickness rotator cuff repair surgery. J Orthop Sports Phys Ther. 2002;32:548–559.PubMedGoogle Scholar
  36. 36.
    Romeo AA, Hang DW, Bach BR, Shott S. Repair of full thickness rotator cuff tears: gender, age, and other factors affecting outcome. Clin Orthop Relat Res. 1999;367:243–255.PubMedCrossRefGoogle Scholar
  37. 37.
    Rosenbaum PR. Propensity Score. In: Armitage P, Colton T, eds. Encyclopedia of Biostatistics. New York, NY: Wiley; 1998:3551–3555.Google Scholar
  38. 38.
    Sallay PI, Hunker PJ, Brown L. Measurement of baseline shoulder function in subjects receiving workers’ compensation versus noncompensated subjects. J Shoulder Elbow Surg. 2005;14:286–297.PubMedCrossRefGoogle Scholar
  39. 39.
    Shinners TJ, Noordsij PG, Orwin JF. Arthroscopically assisted mini-open rotator cuff repair. Arthroscopy. 2002;18:21–26.PubMedGoogle Scholar
  40. 40.
    Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6:274–279.PubMedCrossRefGoogle Scholar
  41. 41.
    Tashjian RZ, Henn RF, Kang L, Green A. The effect of comorbidity on self-assessed function in patients with a chronic rotator cuff tear. J Bone Joint Surg Am. 2004;86:355–362.PubMedGoogle Scholar
  42. 42.
    Tashjian RZ, Henn RF, Kang L, Green A. Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair. J Bone Joint Surg Am. 2006;88:536–540.PubMedCrossRefGoogle Scholar
  43. 43.
    Viola RW, Boatright KC, Smith KL, Sidles JA, Matsen FA 3rd. Do shoulder patients insured by workers’ compensation present with worse self-assessed function and health status? J Shoulder Elbow Surg. 2000;9:368–372.PubMedCrossRefGoogle Scholar
  44. 44.
    Watson EM, Sonnabend DH. Outcome of rotator cuff repair. J Shoulder Elbow Surg. 2002;11:201–211.PubMedCrossRefGoogle Scholar
  45. 45.
    Zakaria D. Rates of carpal tunnel syndrome, epicondylitis, and rotator cuff claims in Ontario workers during 1997. Chronic Dis Can. 2004;25:32–39.PubMedGoogle Scholar
  46. 46.
    Zakaria D, Robertson J, Koval J, MacDermid J, Hartford K. Rates of claims for cumulative trauma disorder of the upper extremity in Ontario workers during 1997. Chronic Dis Can. 2004;25:22–31.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • R. Balyk
    • 1
    • 2
  • C. Luciak-Corea
    • 3
  • D. Otto
    • 1
    • 2
  • D. Baysal
    • 2
  • L. Beaupre
    • 2
    • 4
    • 5
  1. 1.Department of SurgeryCaritas Health GroupEdmontonCanada
  2. 2.Department of SurgeryUniversity of AlbertaEdmontonCanada
  3. 3.Department of Rehabilitation MedicineCaritas Health GroupEdmontonCanada
  4. 4.Department of Physical TherapyUniversity of AlbertaEdmontonCanada
  5. 5.EdmontonCanada

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