Outcomes of rotator cuff surgery: what does the evidence tell us?

Current trends in rotator cuff repair: surgical technique, setting, and cost

PURPOSE

The purpose of this study was to evaluate national trends in the surgical setting and hospital costs of shoulder arthroscopy and rotator cuff repair (RCR) using the Florida State surgical database and national inpatient database.

METHODS

In part I we analyzed population-adjusted shifts in RCR technique (arthroscopic v open) in the Florida surgical database from 2000-2007 and quantified the procedural codes associated with arthroscopic and open RCR. In part II we analyzed the Nationwide Inpatient Sample database from 2001-2009 for the total number of inpatient RCRs, the inpatient hospital type (rural, urban non-teaching, or urban teaching), and the cost.

RESULTS

Part I showed a 163% increase in outpatient procedures in Florida, with a 353% increase in arthroscopic RCRs. There was a concurrent decrease in open RCRs; however, the overall trend was a 2-fold increase in total RCRs. Associated procedures such as subacromial decompression, distal clavicle resection, and extensive glenohumeral debridement increased by 440%, 589%, and 1,253%, respectively. Part II showed an overall 58.8% decrease in inpatient RCRs that was similar across all hospital settings, with an increase in RCR-associated hospital charges by 144.9%, whereas hospital costs only increased by 85.2%.

CONCLUSIONS

The study confirms a shift toward arthroscopic RCR and associated procedures in the outpatient setting. The increased financial cost partly explains the shift; nevertheless, future studies are needed to further examine national trends.

CLINICAL RELEVANCE

This study examining RCR trends by hospital type, cost, and setting further elucidates how orthopaedic surgery practice is evolving with the implementation of arthroscopic RCR in the past decade.

Comparison of subjective and objective outcomes after rotator cuff repair

PURPOSE

To determine whether subjective (pain by visual analog scale) or objective (strength by dynamometer) measures correlate with disease-specific measures and quality-of-life metrics in arthroscopic rotator cuff repair.

METHODS

The study population included patients who underwent primary arthroscopic rotator cuff repair at a single institution between 2006 and 2009. Within these parameters, data from 166 patients was obtained. Data were collected prospectively and reviewed retrospectively. Preoperative and 1-year postoperative data were compared. Correlation was determined in (1) disease-specific metrics including American Shoulder and Elbow Surgeons (ASES) score, Constant score (CS), and Simple Shoulder Test (SST) score and (2) quality of life measured by the Short Form 12.

RESULTS

Preoperative strength and pain are closely associated with postoperative changes (P < 1 × 10(-5), with β coefficients of 0.8 to 1.0). Change in ASES score was most closely associated with change in pain and change in CS with change in strength (R(2) = 0.82 and R(2) = 0.54, respectively). Only the SST score was found to be statistically linked to changes in both strength and pain (P < .05).

CONCLUSIONS

Patients, despite sex and age, with good preoperative strength and high preoperative pain will benefit most from arthroscopic rotator cuff repair. The CS best captures changes in strength, and the ASES score best captures changes in pain. Only changes in the SST score show a statistically significant link with changes in both strength and pain.

LEVEL OF EVIDENCE

Level IV.

Arthroscopic versus mini-open rotator cuff repair: a prospective, randomized study with 24-month follow-up

This prospective, randomized study was performed to evaluate the results of mini-open and arthroscopic rotator cuff repair in a comparative case series of patients followed for 24 months. A total of 125 patients were randomized to mini-open (Group I) or arthroscopic (Group II) rotator cuff repair at the time of surgical intervention. The University of California Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) index, and muscle strength were measured to evaluate the clinical results, while magnetic resonance arthrography was used at 24-month follow-up to investigate the postoperative rotator cuff integrity. Fifty-three patients in Group I and 55 patients in Group II were available for evaluation at 24-month follow-up. At 24-month follow-up, the UCLA score, the ASES index, and muscle strength were statistically significantly increased in both groups postoperatively, while no significant difference was detected between the 2 groups. Intact rotator cuffs were investigated in 42 patients in Group I and 35 in Group II, and there was a significant difference in postoperative structural integrity between the two groups (P < 0.05). When analysis was limited to the patients with full-thickness tear, the muscle strength of the shoulder was significantly better in Group II, and the retearing rate was significantly higher in Group II. Based on the results obtained from this study, it can be indicated that arthroscopic and mini-open rotator cuff repair displayed substantially equal outcomes, except for higher retearing rate in the arthroscopic repair group. While for patients with full-thickness tear, arthroscopic rotator cuff repair displayed better shoulder strength and significantly higher retearing rate as compared to mini-open rotator cuff repair at 24-month follow-up.