Purpose
The purpose of this study is to investigate the outcomes of arthroscopic rotator cuff
repair in a severely obese population (body mass index [BMI] > 0 kg/m2) compared to a healthy weight population (BMI 18.5-24.9 kg/m2).
Methods
This study is a retrospective review of prospectively collected data examining the
outcomes of arthroscopic rotator cuff repair in both severely obese patients and healthy
weight patients. Primary outcome measures analyzed include the American Shoulder and
Elbow Surgeons (ASES) Score, the Single Assessment Numeric Evaluation (SANE), pain
Visual Analog Scale (VAS), range of motion, and complications.
Results
A total of 89 patients met inclusion/exclusion criteria: 52 healthy weight patients
(BMI 18.5-24.9 kg/m2) and 37 severely obese patients (BMI >40 kg/m2). Patient-reported pain and functional outcomes had significantly improved after
surgery in both groups with regard to the visual analog score (VAS) scores, Single
Assessment Numeric Evaluation (SANE) scores, and American Shoulder and Elbow Surgeons
Shoulder (ASES) scores (P < .0001). When directly comparing the outcomes in the healthy weight group to the
severely obese group, the latter had significantly inferior outcomes in VAS scores
(P = .0048), SANE scores (P = .0118), ASES scores (P = .0031), and postoperative internal rotation (P =.0132). At large, these outcomes did not have clinically significant differences.
The severely obese group also had higher total numbers of comorbid conditions and
longer operative times (P =.0041).
Conclusions
Severely obese patients and their associated comorbid conditions pose unique challenges
in rotator cuff tear management, but they still achieve overall excellent outcomes
after repair and noninferior clinical differences when compared to healthy weight
patients.
Level of Evidence
Level III, retrospective comparative study.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of obesity and severe obesity among adults: United States, 2017-2018.NCHS Data Brief. 2020; : 1-8
- Projected U.S. state-level prevalence of adult obesity and severe obesity.N Engl J Med. 2019; 381: 2440-2450
- BMI classification percentile and cut off points.in: StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL)2021
- The surprising effect of body mass index on elective orthopedic surgeries.J Int Soc Phys Rehabil Med. 2019; 2: 50-53
- Prevalence and trends in obesity among US adults, 1999-2008.JAMA. 2010; 303: 235-241
- The association between body fat and rotator cuff tear: The influence on rotator cuff tear sizes.J Shoulder Elbow Surg. 2014; 23: 1669-1674
- Metabolic syndrome: A comprehensive perspective based on interactions between obesity, diabetes, and inflammation.Circulation. 2005; 111: 1448-1454
- Shoulder arthroplasty in morbidly obese patients.J Shoulder Elbow Surg. 2009; 18: 903-906
- The impact of body mass index on complications after shoulder arthroscopy: Should surgery eligibility be determined by body mass index cutoffs?.Arthroscopy. 2019; 35: 741-746
- Establishing clinically significant outcome after arthroscopic rotator cuff repair.J Shoulder Elbow Surg. 2019; 28: 939-948
- Minimal clinically important differences in the American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale pain scores after arthroscopic rotator cuff repair.J Shoulder Elbow Surg. 2020; 29: 1406-1411
- Influence of advanced glycation end products on rotator cuff.J Shoulder Elbow Surg. 2019; 28: 1490-1496
- The effect of obesity on fatty infiltration of the rotator cuff musculature in patients without rotator cuff tears.Shoulder Elbow. 2019; 11: 30-38
- Prognostic factors for recovery after arthroscopic rotator cuff repair: A prognostic study.J Shoulder Elbow Surg. 2015; 24: 1249-1256
- Morphologic risk factors in predicting symptomatic structural failure of arthroscopic rotator cuff repairs: Tear size, location, and atrophy matter.Arthroscopy. 2016; 32: 1947-1952
- Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome.Am J Sports Med. 2007; 35: 719-728
- Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears.J Shoulder Elbow Surg. 2003; 12: 550-554
- Diagnosis and treatment of anterosuperior rotator cuff tears.J Shoulder Elbow Surg. 2001; 10: 37-46
- Level of obesity is directly associated with complications following arthroscopic rotator cuff repair.J Shoulder Elbow Surg. 2021; 30: 1581-1587
- Obesity causes poorer clinical results and higher re-tear rates in rotator cuff repair.Arch Orthop Trauma Surg. 2018; 138: 835-842
- Cerebral desaturation events during shoulder arthroscopy in the beach chair position: patient risk factors and neurocognitive effects.J Shoulder Elbow Surg. 2013; 22: 1228-1235
- Prevalence and risk factors for lateral femoral cutaneous nerve palsy in the beach chair position.Arthroscopy. 2017; 33: 1958-1962
- Outcomes of arthroscopic rotator cuff repairs in obese patients.J Shoulder Elbow Surg. 2011; 20: 961-967
- Editorial Commentary: Go ahead and repair that shoulder rotator cuff tear in your obese patient: Just be prepared to admit them.Arthroscopy. 2018; 34: 762-763
- Quantifying how big is too big for ambulatory surgery. Anesthesia Experts. Available at:.http://anesthesiaexperts.com/uncategorized/quantifying-big-big-ambulatory-surgery/Date accessed: October 6, 2021
- The cost of outpatient arthroscopic rotator cuff repairs: Hospital reimbursement is on the rise while surgeon payments remain unchanged.Arthroscopy. 2020; 36: 2354-2361
- The effect of preexisting and shoulder-specific depression and anxiety on patient-reported outcomes after arthroscopic rotator cuff repair.Am J Sports Med. 2019; 47: 3073-3079
- Does rotator cuff repair improve psychologic status and quality of life in patients with rotator cuff tear?.Clin Orthop Relat Res. 2015; 473: 3494-3500
- Limits of body mass index to detect obesity and predict body composition.Nutrition. 2001; 17: 26-30
- Factors affecting rotator cuff healing.J Bone Joint Surg Am. 2014; 96: 778-788
- Comorbidity effect on speed of recovery after arthroscopic rotator cuff repair.JSES Open Access. 2018; 2: 60-68
Article info
Publication history
Published online: March 09, 2022
Accepted:
February 21,
2022
Received:
October 17,
2021
Footnotes
The authors report no conflicts of interest in hte authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
