Although excellent outcomes have clearly been shown after arthroscopic rotator cuff repair (ARCR), the subset of Workers’ Compensation (WC) patients has long been recognized as having inferior results after various shoulder surgeries compared with non-WC patients.
After rotator cuff repair specifically, a number of series have shown inferior results in WC patients. Essman noted good to excellent results in only 42% of their WC patients versus 72% of non-WC patients, and Hawkins noted in their series of 100 rotator cuff repairs that outcomes in WC patients were inferior to those in patients not receiving WC, with WC patients less likely to return to work (RTW). Likewise, in a retrospective review of 103 consecutive open rotator cuff repairs performed by Misamore only 54% of WC patients had good to excellent results versus 92% of non-WC patients; the authors also noted that WC patients less frequently returned to full activity (42% v 94%) or to strenuous occupations (20% v 95%). Watson and Sonnabend found that WC patients were 3.1 times more likely to be displeased after surgery than non-WC patients, with an overall patient satisfaction rate of only 71% (v 90% for non-WC patients). WC patients were also noted to report less pain reduction and less improvement in work ability after surgery than their non-WC counter-parts. However, these studies have focused on subjective outcomes as their primary outcome measure.
Although these studies show generalized diminished outcomes in WC patients as a subset of larger patient cohorts, few studies have focused on outcomes after arthroscopic repair, and no study has looked at postoperative work level as the primary outcome measure. The purpose of this study was to investigate the ability of patients to return to their preoperative work level and to identify functional prognostic factors in a group of WC patients after arthroscopic repair of full-thickness rotator cuff tears at a minimum follow-up of 1 year.
Our hypothesis was that WC patients would have a satisfactory return to preinjury levels of function after arthroscopic repair of full-thickness rotator cuff tears. The ability to predict RTW level and to identify potential prognostic variables in this unique, but significant, patient population would assist orthopaedists in advising both patients and employers regarding realistic recovery expectations.