Summary

WC patients are on average 8 years younger than non-WC patients but have lower clinical outcome scores at week 26 compared with non-WC patients. Paradoxically however, WC patients have better healing with inferior retear rates and therefore, it is speculated, a better long-term prognosis. This result is helpful in the counselling of these patients and the formation of rehabilitation plans.

Abstract

Introduction

Rotator cuff tears (RCTs)are significantly more common in manual workers referred to as workers’ compensation patients (WC), especially those involved in repetitive overarm lifting compared to the general population. RCTs are therefore a burden on the health care system as well as the manual workers, who are cared for under the WC insurance. The purpose of this study was to compare the functional outcome and retear rate of arthroscopic repair of full-thickness rotator cuff tear (FTRCT) in WC compared to non-WC patients.

Methods

A total of 301 patients with FTRCT were included. 243 non-WC patients and 58 WC patients that required an arthroscopic rotator cuff repair between 2012 and 2020 with completed serial ultrasound examinations at weeks 6, 12, and 26 postoperatively were included. The time point for examination of cuff integrity was six months, based on the rotator cuff repair healing studies. Functional clinical scores were assessed by Constant score, Western Ontario Rotator Cuff Index (WORC), and Oxford score. Details were retrieved from the Socrates Orthopaedic Outcomes Software database. Surgical procedures were performed by the same experienced senior surgeon (MH). All patients had undergone an arthroscopic suture bridge repair technique.

Results

Statistically, a significant difference was observed between the mean age of patients. 63 years ± 8.28 for the non-WC group and 55 years ± 7.52 for the WC group (p=.001). No differences in the grade of tendinopathy were observed between both groups. Clinical outcomes were significantly improved at week 26 of all three scores (p=<0.05) compared to preoperative scores in both groups. WC patients have statistically significant inferior Total Oxford Scores and WORC Total score preoperatively, at week 12 and at week 26 compared with non-WC patients (p=<0.05). No differences between preoperatively Constant Scores were observed between both groups. Although subjective Constant score was statistically significantly lower in the WC group (15.69 ±7.5 vs 18.51 ± 6.5 p=<0.05). The Constant score at week 26 reflected statistically significant differences with lower scores for the WC group (61.9 ±18.5 vs 66.5 ± 16.3 p==0.01). However, the WC group has a significantly inferior complete retear rate at week 12 (1.7% vs 5.8%) and at week 26 (1.7% vs 7.8% p=<0.05). No differences in retear rate were found at week 6.

Conclusion

These results demonstrate that WC patients are on average 8 years younger than non-WC patients, suggesting that manual labour is a substantial contributing factor to RCTs. WC patients have lower outcomes, at week 12 and at week 26 compared with non-WC patients. However, paradoxically, our study showed that WC patients have better healing with inferior retear rates and therefore, it is speculated, that a better long-term prognosis. Better healing may be in part because they are reluctant to push their rehabilitation due to greater pain, and their younger age. Short-term clinical outcomes of WC patients have worse results than those who don’t have a WC claim. This result is helpful in the counseling of these patients and the formation of rehabilitation plans.