title: Outcomes assessment in rotator cuff pathology: what are we measuring?
abstract: BACKGROUND
  Assessments used to measure outcomes associated with rotator cuff pathology and after repair are varied. This lack of standardization leads to difficulty drawing comparisons across studies. We hypothesize that this variability in patient-reported outcome measures and objective metrics used in rotator cuff studies persists even in high-impact, peer reviewed journals.
  
  
  METHODS
  All studies assessing rotator cuff tear and repair outcomes in 6 orthopedic journals with a high impact factor from January 2010 to December 2014 were reviewed. Cadaveric and animal studies and those without outcomes were excluded. Outcome measures included range of motion (forward elevation, abduction, external rotation, and internal rotation), strength (in the same 4 planes), tendon integrity imaging, patient satisfaction, and functional assessment scores.
  
  
  RESULTS
  Of the 156 included studies, 63% documented range of motion measurements, with 18% reporting range of motion in all 4 planes. Only 38% of studies reported quantitative strength measurements. In 65% of studies, tendon integrity was documented with imaging (38% magnetic resonance imaging/magnetic resonance anrhrogram, 31% ultrasound, and 8% computed tomography arthrogram). Finally, functional score reporting varied significantly, with the 5 most frequently reported scores ranging from 16% to 61% in studies, and 15 of the least reported outcomes were each reported in ≤6% of studies.
  
  
  CONCLUSIONS
  Significant variability exists in outcomes reporting after rotator cuff tear and repair, making comparisons between clinical studies difficult. Creating a uniformly accepted, validated outcomes tool that assesses pain, function, patient satisfaction, and anatomic integrity would enable consistent outcomes assessment after operative and nonoperative management and allow comparisons across the literature.
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: ericmakhnimd@gmail.com.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Makhni
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Steinhaus
authors.affiliation: Drexel Medical School, Philadelphia, PA, USA.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Morrow
authors.affiliation: Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Jobin
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bach
mesh_terms: D000818:Animals; D001175:Arthrography; D001182:Arthroscopy / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D017063:Outcome Assessment, Health Care; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D013708:Tendon Injuries / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Rotator cuff tear; outcomes; patient-reported outcomes; rotator cuff repair