title: The Relationship Between Intraoperative Tear Dimensions and Postoperative Pain in 1624 Consecutive Arthroscopic Rotator Cuff Repairs.
abstract: BACKGROUND
  Rotator cuff repair often results in significant pain postoperatively, the cause of which is undetermined. Purpose/Hypothesis: The aim of this study was to evaluate the relationship between rotator cuff tear area and postoperative pain in patients who had undergone arthroscopic rotator cuff repair. We hypothesized that larger tears would be more painful because of elevated repair tension at 1 week postoperatively but that smaller tears would be more painful because of a greater healing response, especially from 6 weeks postoperatively.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  A total of 1624 patients who underwent arthroscopic rotator cuff repair were included in this study. Exclusion criteria were moderate to severe osteoarthritis, isolated subscapularis repair, calcific tendinitis, synthetic patch repair, revision surgery, and retears on ultrasound at 6 months after surgery. Rotator cuff tears were subdivided into groups based on the tear size and retear rate found for each group. A modified L'Insalata questionnaire was given before surgery and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Pearson and Spearman correlation coefficient tests were performed between rotator cuff tear areas and pain scores.
  
  
  RESULTS
  Intraoperative rotator cuff tear areas did not correlate with pain scores preoperatively or at 1 week after surgery. A smaller tear area was associated with more frequent and severe pain with overhead activities, at rest, and during sleep as well as a poorer perceived overall shoulder condition at 6 weeks, 3 months, and 6 months after repair ( r = 0.11-0.23, P < .0001). Patients who were younger, had partial-thickness tears, and had occupational injuries experienced more pain postoperatively ( r = 0.10-0.28, P < .0001). Larger tears did not have more pain at 1 week after surgery. The retear rate was 7% in tears <2 cm2but reached 44% in tears >8 cm2.
  
  
  CONCLUSIONS
  There were fewer retears with smaller tears, but they were more painful than large tears postoperatively from 6 weeks to 6 months after surgery. Smaller tears may heal more vigorously, causing more pain. Patients with smaller tears experienced more pain after rotator cuff repair compared with patients with larger tears. These findings are contrary to previous ideas about tear size and postoperative pain. Healing is likely a determinant of postoperative pain.
authors.affiliation: Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Daniel Y T
authors.initials: DY
authors.lastname: Yeo
authors.affiliation: Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Judie R
authors.initials: JR
authors.lastname: Walton
authors.affiliation: Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lam
authors.affiliation: Orthopaedic Research Institute, St George Hospital, University of New South Wales, Sydney, Australia.
authors.forename: George A C
authors.initials: GA
authors.lastname: Murrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology*; D011184:Postoperative Period; D012189:Retrospective Studies; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
keywords: arthroscopic rotator cuff repair; healing; postoperative pain; rotator cuff tear size; tear area