Greater Socioeconomic Disadvantage as Measured by the Area Deprivation Index Is Associated With Failure of Healing Following Arthroscopic Repair of Massive Rotator Cuff Tears but Not With Clinical Outcomes
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Tarih
2024
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Dergi ISSN
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Yayıncı
W.B. Saunders
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Purpose: To analyze the relationship between Area Deprivation Index (ADI) and preoperative status and short-term postoperative clinical outcomes among patients who underwent arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (MRCTs). Methods: A retrospective review was conducted on prospectively maintained data on patients who underwent ARCR of MRCTs defined as tear size ?5 cm or complete tear of at least 2 tendons, with a minimum 2-year follow-up and a valid home address between January 2015 and December 2018. Each patient's home address was mapped to the ADI to determine neighborhood disadvantage. This composite index is composed of 17 census-based indicators, including income, education, employment, and housing quality to quantify the level of socioeconomic deprivation. Ratings were recorded and categorized based on the sample's percentile. Patients were then divided into 2 groups: upper quartile (ie, most disadvantaged [?75th percentile]) and lower 3 quartiles (ie, least disadvantaged [<75th percentile]). Bivariate analysis was performed to associate ADI with patient-reported outcomes (PROs) and range of motion pre- and postoperatively, as well as complications, healing rate, satisfaction, and return to work. Patients reaching or exceeding the minimal clinically important difference for visual analog scale (VAS), American Shoulder and Elbow Surgeons, Veterans Rand 12-Item questionnaire, and subjective shoulder value were recorded for both cohorts. Results: Ninety-nine patients were eligible for study analysis. Preoperative PROs and range of motion were similar, except for a greater VAS for pain (6.3 vs 4.3; P < .01) and lower American Shoulder and Elbow Surgeons score (32.2 vs 45.1; P = .01) in the most disadvantaged group. Both groups showed similar postoperative PROs scores, but greater VAS improvement was seen in the upper quartile group (? 4.2 vs ? 3.0; P = .04). In contrast, only the least-disadvantaged group significantly improved in internal rotation (P = .01) and forward flexion (18°; P < .01) from baseline. Although satisfaction, complications, and return to work were comparable (P > .05), failure of healing occurred more frequently in the most disadvantaged group (21% vs 6%; P = .03). Conclusions: Patients with MRCTs residing in the most disadvantaged neighborhoods as measured by the ADI have more pain and functional limitations before undergoing ARCR but demonstrate similar postoperative functional improvements to patients from other socioeconomic backgrounds. Failure of healing of MRCTs may be more common in disadvantaged groups. Furthermore, both groups reported similar rates of clinically important functional improvement. Level of Evidence: Level III, retrospective cohort comparison. © 2023 Arthroscopy Association of North America
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Anahtar Kelimeler
acromioplasty; aged; American Shoulder and Elbow Surgeons score; arthroscopic rotator cuff repair; Article; clinical outcome; cohort analysis; controlled study; disadvantaged population; education; employment; female; follow up; general anesthesia; healing; healing rate; housing quality; human; income; joint mobility; major clinical study; male; minimal clinically important difference; neighborhood; nuclear magnetic resonance imaging; patient-reported outcome; postoperative period; preoperative period; prospective study; range of motion; retrospective study; return to work; rotator cuff rupture; satisfaction; socioeconomics; tenodesis; tenotomy; visual analog scale; arthroscopy; health disparity; pain; rotator cuff injury; rupture; treatment outcome; Arthroscopy; Humans; Pain; Range of Motion, Articular; Retrospective Studies; Rotator Cuff Injuries; Rupture; Socioeconomic Disparities in Health; Treatment Outcome
