The shoulder function "tipping-point" for elective rotator cuff repair: demographic and longitudinal trends

A patient's decision to undergo an elective orthopedic procedure is largely based on their symptoms and functional limitations. This point where patients choose to undergo surgery is known as the "tipping point." The primary aim of this study is to determine the relationship between demographic parameters and the tipping point for elective rotator cuff repair. The secondary aim is to investigate if the tipping point is associated with mental health. The tertiary aim is to determine if the tipping point changes over time.

Retrospective chart review was used to identify all patients who underwent primary arthroscopic rotator cuff repair between January 1, 2015, to January 1, 2020, with 1 of 3 board-certified orthopedic surgeons. Exclusion criteria included age <18 years, revision surgery, or incomplete datasets (American Shoulder and Elbow Surgeons [ASES], 12-item short form, demographic information, and surgical history). Preoperative ASES score was designated as the tipping point for an individual patient, with a lower score representing worse shoulder function and therefore a higher tipping point and vice versa. Demographic parameters (age, sex, body mass index [BMI], race, and insurance), hand dominance, and surgical history extracted from chart review were analyzed to determine associations with tipping point.

A total of 2153 patients were identified from chart review, with 1731 included in the final analysis. The patients had a mean age of 58.6 ± 9.66 years and a mean BMI of 29.2 ± 6.02 kg/m². There was no significant difference in mean preoperative ASES score by year for the duration of this study (2015-2019, P = .27). Worker's compensation patients had a significantly lower mean preoperative ASES score than patients with commercial or government insurance (P < .01). Spearman's rank correlations showed no relationship between ASES score and patient demographics (age, sex, BMI, race, and hand dominance) or between ASES and previous orthopedic surgery. Preoperative ASES showed a weakly positive correlation (ρ = 0.26) with 12-item short form mental component score. Multivariate linear regression showed male sex is predictive of a lower tipping point (P < .01), whereas higher BMI, African American race, and history of arthroplasty are predictive of a higher tipping point (P ≤ .02).

The tipping point was not demonstrated to change over time in our analysis. Male sex is predictive of a lower tipping point for arthroscopic rotator cuff repair, whereas elevated BMI, African American race, worker's compensation insurance, and prior arthroplasty are predictive of a higher tipping point. Also, better mental health function is associated with a lower tipping point.