Background: We are not aware of any previous studies of the
relationship between patients' expectations regarding rotator cuff repair and
the actual outcome. We hypothesized that preoperative expectations are
predictive of the outcome of rotator cuff repair.
Methods: One hundred and twenty-five patients who underwent
unilateral primary repair of a chronic rotator cuff tear were included in the
study. All operations were performed by a single surgeon. Each patient
prospectively completed the Simple Shoulder Test (SST); the Disabilities of
the Arm, Shoulder and Hand (DASH) questionnaire; three visual analogue scales
for shoulder pain, shoulder function, and quality of life; and the Short
Form-36 (SF-36) preoperatively and at one year (mean and standard deviation,
54.1 ± 7.6 weeks) postoperatively. Preoperative expectations were
quantified with use of six questions from the Musculoskeletal Outcomes Data
Evaluation and Management System (MODEMS) questionnaire.
Results: Greater preoperative expectations correlated with better
postoperative performance on the SST, DASH, each visual analogue scale, and
the SF-36 (p values ranging from <0.0001 to 0.03) as well as with greater
improvement from the baseline scores on the DASH and SF-36 (p values ranging
from <0.0001 to 0.018). A rigorous multivariate analysis controlling for
age, gender, smoking, Workers' Compensation status, symptom duration, number
of previous operations, number of comorbidities, tear size, and repair
technique confirmed that greater expectations were a significant independent
predictor of both better performance at one year and greater improvement on
the SST, the DASH, each visual analogue scale, and the SF-36 (p values ranging
from <0.001 to 0.042).
Conclusions: Patients' preoperative expectations regarding rotator
cuff repair are associated with their actual self-assessed outcome. Variations
in patient expectations may help to explain divergent results in published
series as well as among various patient populations.
Level of Evidence: Prognostic Level I. See Instructions
to Authors for a complete description of levels of evidence.