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30% Poor Outcomes After Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears Without Arthritis


The SANE score is the response to a single question: “How would you rate your affected shoulder as a percentage of normal (0% to 100% scale with 100% being normal)?” By contrast the Simple Shoulder Test (SST) and American Shoulder and Elbow (ASES) scores are based on the answers to multiple questions about shoulder pain and comfort.

The authors of Preoperative Single Assessment Numeric Evaluation Score Predicts Poor Outcomes After Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears Without Arthritis conducted a retrospective case-control study of factors predictive of poor outcomes after reverse shoulder arthroplasty performed by fellowship trained surgeons for 60 patients (mean age, 71.4±7.4 years) with massive rotator cuff tears without glenohumeral arthritis (Hamada score ≤3) having a minimum of 2 years of follow-up. Of these, 18 (30%) patients had poor outcomes as defined by one of more of the following:

ASES score of less than 50 

change in ASES score of less than 12

change in SST score of 1 or less

change in SANE score of less than 29

postoperative active forward elevation of less than 90°

revision surgery.

There was no obvious reason (eg, infection, dislocation, nerve injury) for poor outcomes.

The characteristic and outcomes for the controls (good outcomes) and cases (poor outcomes) are shown below 

This study found that higher preoperative SANE scores – but not the preoperative ASES and SST scores – were associated with a greater likelihood of poor outcome after RSA for massive rotator cuff tears.

As seen in the chart below, the preperative ASES and SST scores were the same for the control and case groups, whereas the preoperative SANE scores were higher for the case group than the control group. Thus the preoperative SANE scores did not correlate with the preoperative SST and ASES scores. This finding is unexplained in that the authors of Can the Single Assessment Numeric Evaluation (SANE) be used as a stand-alone outcome instrument in patients undergoing total shoulder arthroplasty? found that the correlation was excellent for the SANE score and the ASES score (n = 1447, r = 0.82, P < .0001), and the SST score (n = 1095, r = 0.81, P < .0001).

Comment: It is of interest that by the standards used in this study, almost 1/3 of patients with massive cuff tears without arthritis experienced a poor outcome after reverse total shoulder. Further clinical research is needed to establish the patients likely to experience poor outcomes so that alternate methods of management can be considered.

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