A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors

Abstract

Hypothesis: We evaluated the correlation of preoperative factors with pain after arthroscopic rotator cuff repair (ARCR). We hypothesized that nonstructural factors, including metrics of psychological well-being and preoperative narcotic use, would correlate with higher pain levels postoperatively and that structural factors, such as tear size, would not be predictive.

Methods: Ninety-three patients were prospectively enrolled and evenly distributed by tear size. Patient sex, age, occupation, smoking status, tear mechanism, tear characteristics on magnetic resonance imaging, visual analog scale (VAS) pain scores, narcotic usage, range of motion (ROM) by goniometry, and functional and psychological assessments through the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, Simple Shoulder Test, Western Ontario Rotator Cuff Index (WORC), and RAND 36-item Short Form Survey questionnaires were obtained preoperatively. VAS scores and ROM were collected postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. The ASES, SST, WORC, and RAND 36-item Short Form Survey questionnaires were repeated 1 year postoperatively.

Results: The patients (54% men) were a mean age of 56.4 years. There were 68% traumatic tears, 11% smokers, and 13% used narcotics preoperatively. ROM, VAS, ASES, and WORC scores improved significantly from the preoperative to 1-year postoperative assessment. Correlating with increased pain scores at 1 year were preoperative narcotic use, higher preoperative VAS, and lower scores on the WORC index and emotion sections.

Conclusion: Our data show that the factors most predictive of persistent pain after ARCR are psychosocial characteristics, including poor performance on validated measures of emotional well-being. Demographic and tear-specific structural factors did not correlate with postoperative pain scores.

Keywords: Rotator cuff; arthroscopic repair; pain; prediction models; psychosocial; well-being.