Outcome evaluation after reconstructive surgery for muscuoloskeletal diseases. A comparative assessment of new evaluative procedures

Outcome evaluation is becoming increasingly important for reconstructive su rgery in musculosceletal diseases. In addition to established shoulder-scor es, new outcome-scores are being developed to cover all effects caused by a disease or intervention. Three validated, self-administered shoulder quest ionnaires were applied prospectively in 23 otherwise healthy patients suffe ring from rotator cuff deficiency. These were correlated to the Constant-Mu rley Shoulder Score and to a visual analogue scale for satisfaction. 7 wome n and 16 men with combined tears of supraspinatus and infraspinatus (mean a ge 55.3 +/- 10.5, r/l: 14/9, FU 57.8 +/- 15.7 weeks) were gathered prospect ively and evaluated pre- and postoperatively with the American Shoulder and Elbow Surgeons Shoulder Index (ASES), the Simple Shoulder Test (SST) and t he Disabilities of the Arm, Shoulder and Hand Module (DASH questionnaire). In addition, a visual analogue scale for satisfaction was employed. All fou r scores as well as the visual analogue scale revealed improvement at a sta tistically significant level (paired,two-tailed t-test, P < 0.01) after sur gery. All questionnaires had a significant correlation with the Constant-Murley S houlder Score (Pearson's correlation coefficient: ASES: r = 0.871, P < 0.01 ; DASH: r = -0.758, P = < 0.01; SST: r = 0.494, P < 0.05). All were easy to apply and provided a reliable, postoperative evaluation of shoulder functi on. The SST was easy to apply, however compound outcome analysis was only p ossible with the ASES Shoulder Index and the DASH questionnaire. The DASH s cale was the most complex evaluation instrument. The Constant-Murley Should er Score comprises a physical examination which is advantageous but must be carried out in the clinic. For postoperative assessment, without the patie nt having to return to the clinic,the ASES Shoulder Index is preferred as i t correlates well with the Constant-Murley Shoulder Score (r = 0.871) and t he visual analogue scale for satisfaction (r = 0.762).