Baseline characteristics and 2-year functional outcome data of patients undergoing an arthroscopic rotator cuff repair in Switzerland, results of the ARCR_Pred study

Abstract

The ARCR_Pred study was initiated to document and predict the safety and effectiveness of arthroscopic rotator cuff repair (ARCR) in a representative Swiss patient cohort. In the present manuscript, we aimed to describe the overall and baseline characteristics of the study, report on functional outcome data and explore case-mix adjustment and differences between public and private hospitals. Between June 2020 and November 2021, primary ARCR patients were prospectively enrolled in a multicenter cohort across 18 Swiss and one German orthopedic center. Baseline characteristics, including sociodemographic and diagnostic variables, were reported. Clinical scores and patient-reported outcome measures were assessed up to 24-month follow-up. After screening 2350 individuals, 973 patients with ARCR were included. Follow-up rates reached 99%, 95%, 89% and 88% at 6 weeks, 6, 12, and 24 months, respectively. While the proportion of massive tears was higher in the study population (44% vs. 20%, Std. Diff. = 0.56), there were no other major differences in key characteristics between enrolled and non-enrolled patients or in patients lost to follow-up. Functional scores improved over time, with positive changes rates ranging from 83% to 92% at 6-month, reaching 91% to 97% at 12- and 24-month follow-up. In linear mixed models, used to estimate the associations between baseline factors, hospital type and standardized 0-100 scores, marginal effects for time ranged from 20 to 30, 28 to 39 and 34 to 41 points at the 6-, 12- and 24-month follow-up, respectively. Except at the 12-month follow-up, where marginal effects for the interaction terms ranged from -5 to -4 points in the standardized scores, there were no consistent outcome differences between public and private hospitals. Increasing number of years of education was consistently associated with better scores, greater feelings of depression and anxiety, smoking and ASA group III-IV were consistently associated with worse scores. Tear severity showed a consistent negative association solely for the Constant-Score. The ARCR_Pred study shows high potential for generalizability to the population of patients undergoing an ARCR in Switzerland. Further analyses are needed to establish relevant clinimetrics for the Swiss population and to compare outcomes for surgical techniques, surgeon experiences profiles and post-operative management.

Fig 1. Geographical distribution of ARCR_Pred cohort study centers.

Note: Yellow and blue text indicate public and private hospital study centers, respectively. Study centers located in the same city are listed alphabetically.

Fig 2. Patient selection flowchart and follow-up.

This figure presents the ARCR_Pred patient selection and follow-up flow. Abbreviations: ARCR: Arthroscopic Rotator Cuff Repair; MRI: Magnetic Resonance Imaging.

Fig 3. Distribution of key baseline characteristics across study centers.

This figure shows the distribution of six baseline characteristics across the 19 study centers. Red lines correspond to: (A) overall median age (57 years); (B) overall proportion of males (63%); (C) overall median BMI (26.4 kg/m²) and (E) overall proportion of traumatic tears (53%).

Fig 4. Patients functional scores.

This figure shows median (dots), 25^th and 75^th quantile (error bars) of rescaled score values (on a 0–100 scale) over time.