From tear to repair: A systematic review of frequently asked questions before rotator cuff surgery.

Recently there have been several evolving trends in the practice of shoulder surgery. Arthroscopic subacromial decompression has been performed with greater frequency by orthopaedic surgeons, and there has been considerable recent interest in arthroscopic rotator cuff repair. The purpose of this study was to identify trends in practice patterns for subacromial decompression and rotator cuff repair over time and in relation to the location of practice, fellowship training, and declared subspecialty of the surgeon. We reviewed the American Board of Orthopaedic Surgery Part II database to identify patterns in the utilization of open and arthroscopic subacromial decompression and rotator cuff repair among candidates for board certification. All procedures involving only arthroscopic or open subacromial decompression and/or rotator cuff repair from 2004 to 2009 were identified. The rates of arthroscopic and open subacromial decompression and/or rotator cuff repair were compared in terms of year, geographic region, fellowship training, and declared subspecialty of the surgeon. Between 2004 and 2009, 12,136 surgical procedures involving only arthroscopic or open subacromial decompression and/or rotator cuff repair were performed. There were significant differences in treatment with respect to year, geographic region of practice, declared subspecialty, and fellowship training (p < 0.001). There was a significant increase over time in the utilization of arthroscopy among all candidates (p < 0.001). Surgeons with sports medicine fellowship training or a sports-medicine-declared subspecialty performed significantly more subacromial decompressions and rotator cuff repairs arthroscopically than all other candidates (p < 0.001). During this time period, there was a significant decrease in the rate of arthroscopic subacromial decompression, both as an isolated procedure and combined with arthroscopic rotator cuff repair (p < 0.001). From 2004 to 2009, there was a significant shift throughout the United States toward arthroscopic rotator cuff repair and subacromial decompression among young orthopaedic surgeons, with sports medicine fellowship-trained surgeons performing more of their procedures arthroscopically than surgeons with other training. However, there was an increasing frequency of arthroscopic rotator cuff repair performed without subacromial decompression, and, overall, there was a decrease in the frequency of isolated arthroscopic subacromial decompression over time.

Performance and return to sport following rotator cuff surgery in professional baseball players

What are patients asking and reading online? An analysis of online patient searches for rotator cuff repair.

Failed rotator cuff surgery that resulted in reverse total shoulder arthroplasty within 5 years or less: a descriptive analysis of 42 shoulders from a US integrated healthcare system

Does diabetes mellitus predispose to both rotator cuff surgery and subsequent failure?

Context: There are many studies in the literature looking into factors affecting outcomes in rotator cuff surgery. The aetiology of rotator cuff deficiency is often multi-factorial and there are many facets towards successful management in this often debilitating condition. Evidence Acquisition: We performed a literature search of MEDLINE and Embase databases using the terms large rotator cuff tears, fatty infiltration rotator cuff, rotator cuff atrophy, rotator cuff augmentation, rotator cuff tendon transfers, allografts rotator cuff repair, xenograft rotator cuff repair and synthetic grafts rotator cuff repair. Results: In this article, we focus particularly on the aetiology, pathology and prognosis of large tears, fatty infiltration and muscle atrophy of the rotator cuff. An overview of the various treatment strategies and current/future concepts are also discussed in managing patients with these types of rotator cuff deficiencies. Conclusions: Large tears, fatty infiltration and muscle atrophy of the cuff are challenging. An in-depth understanding of these elements may prove vital for the practising orthopedician in determining the right course of management. Techniques in strengthening the repair construct using augmentation play an important role in the treatment of this condition.

The effects of nonsteroidal anti-inflammatory medications after rotator cuff surgery: a randomized, double-blind, placebo-controlled trial.

Outcomes of Rotator Cuff Surgery: What Does the Evidence Tell Us?

Excessive expression of proinflammatory cytokines after rotator cuff (RC) surgery impairs the quality of tendon-bone interface (TBI) healing. There is evidence that the asthma drug montelukast (MS) inhibits the expression of proinflammatory cytokines. This study was conducted to verify the effect of MS administration on TBI healing after RC repair. Thirteen rats in the MS group were intraperitoneally administered 10 mg/kg of the drug daily for 2 weeks after RC surgery, and 13 rats in the control group were administered only 0.9% saline. The healing effect of the TBI was assessed through histologic and biomechanical analysis 4 weeks after tendon repair. In the MS group, the expression of interleukin-1 beta (IL-1β; P<.01) and interleukin 6 (IL-6; P<.01) was significantly reduced compared with the control group. In the evaluation of supraspinatus fatty infiltration, the MS group showed significant inhibition of fatty infiltration compared with the control group (P<.001). Histologic analysis showed that the MS group had significant improvements in collagen density (P=.035) and alignment (P=.011). Biomechanical analysis after systemic administration of MS showed an increase in the cross-sectional area (P<.001) and elongation (P<.01) of the TBI. The use of MS improved tendon elasticity through suppressing fatty infiltration and improving TBI collagen density and arrangement. The mechanism is down-regulation of IL-1β and IL-6. These results strongly support the use of MS as an anti-inflammatory agent that does not impair tendon healing. [Orthopedics. 2025;48(2):e105-e112.].

BackgroundShoulder pain is a common problem in the general population and is responsible for prolonged periods of disability, loss of productivity, absence from work and inability to carry out household activities. Rotator cuff problems account for up to 70% of shoulder pain problems and are the third most prevalent musculoskeletal disorder after those occurring in the lower back and neck. Rotator cuff surgery has high failure rates (25–50% within 12 months), and as a result, there is a pressing need to improve the outcome of rotator cuff surgery. Patch augmented surgery for rotator cuff repairs has recently been developed and is increasingly being used within the UK National Health Service. Patch augmented surgery could lead to a dramatic improvement in patient and surgical outcomes, but its clinical and cost effectiveness needs rigorous evaluation. The existing evidence on the use of patches may be at risk of bias as currently only a small number of single-centre comparative studies appear to have been carried out. Additionally, it is unclear for which patches a clinical study (comparative and non-comparative) has been conducted. This paper outlines the protocol for a systematic review intended to summarise the best available clinical evidence and will indicate what further research is required.MethodsElectronic databases (Medline, Embase and Cochrane) will be systematically searched between April 2006 and the present day for relevant publications using a specified search strategy, which can be adapted for the use in multiple electronic databases, and inclusion criteria. Screening of both titles and abstracts will be done by two independent reviewers with any discrepancies resolved by a third independent reviewer. Data extraction will include information regarding the type of participants, type of intervention and outcomes including but not limited to shoulder-specific function and pain scores, patch-related adverse events and type of study. The results will be summarised in a narrative review where qualitative analysis is not possible.DiscussionThis review aims to collate the current evidence base regarding the use of patches to augment rotator cuff repair. The results of this review will help to develop, using consensus methods, the design of a definitive randomised trial assessing the clinical and cost-effectiveness of a patch to augment surgical repair of the rotator cuff that is both acceptable to stakeholders and is feasible.Systematic review registrationCRD42017057908

Trends in rotator cuff surgery: Research through the decades

In Patients With Rotator Cuff Tears, Female, Hispanic, African American, Asian, Socially Deprived, Federally Insured, and Uninsured Patients Are Less Commonly Treated Surgically

Local anesthetic administered directly to the operative site by slow infusion has become a popular supplementary pain management strategy following rotator cuff surgery, but it is expensive and there is little conclusive evidence that it provides additional benefits. The purpose of this study was to determine the effectiveness and safety of ropivacaine infusion following arthroscopic or mini-incision rotator cuff surgery. We performed a randomized, participant and outcome assessor-blinded, placebo-controlled trial. Participants, stratified by operative procedure (either arthroscopic decompression or rotator cuff repair), were given preemptive 1% ropivacaine (20 mL) and intraoperative intravenous parecoxib (40 mg) and were randomly assigned to 0.75% ropivacaine or placebo by elastomeric pump at 5 mL/hr. Pain at rest was reported on a verbal analogue scale at fifteen, thirty, and sixty minutes and at two, four, eight, twelve, eighteen, and twenty-four hours. The use of alternative analgesia, delay in discharge, and adverse events, including development of stiff painful shoulder, infection, and leakage, were also assessed. Eighty-eight participants received arthroscopic decompression (forty-three in the placebo arm and forty-five in the ropivacaine arm) and seventy received rotator cuff repair (thirty-five participants in each treatment arm). Compared with placebo, ropivacaine infusion resulted in a significant but clinically unimportant improvement in average pain in the first twelve hours following both procedures (the average pain score was 1.62 and 2.16 for the ropivacaine and placebo arms, respectively, in the arthroscopic decompression group and 2.12 and 2.82 in the rotator cuff repair group, with a pooled difference between groups of 0.61; 95% confidence interval, 0.22 to 1.01; p = 0.003). When adjusted for opioid use, the pooled difference between groups was 0.49 (95% confidence interval, 0.12 to 0.86; p = 0.009). No difference was detected between groups with regard to the maximum pain in the first twelve hours or the average or maximum pain in the second twelve hours, with or without adjustment for opioid use, and no difference was found between groups with regard to the amount of oral analgesia used. No difference was detected between groups with regard to the prevalence of nausea and vomiting, catheter leakage, delayed discharge, or stiff painful shoulder, and no participant in either group had a postoperative infection develop. We found minimal evidence to support the use of ropivacaine infusion for improving outcomes following rotator cuff surgery in the setting of preemptive ropivacaine and intraoperative parecoxib.

Objectives:Recent studies have highlighted that the subacromial bursa, a tissue traditionally discarded during rotator cuff surgeries, has significant regenerative potential. The premise is that processing and applying this tissue to the repair site during surgery could enhance healing and improve procedural success rates. However, further research is essential to validate whether augmenting rotator cuff surgery with subacromial bursa tissue enhances healing outcomes and surgical efficacy. This prospective randomized clinical trial (RCT) aimed to evaluate the effects of bursa augmentation on patient-reported outcomes and MRI findings after arthroscopic rotator cuff repair surgery. We hypothesized that bursa augmentation would improve outcomes compared to standard rotator cuff repair.Methods:Patients undergoing rotator cuff repair of a posterosuperior rotator cuff tear participated in this IRB-approved, longitudinal, double-blinded, randomized controlled trial (RCT). All participants underwent a transosseous equivalent double-row rotator cuff repair, during which a subacromial bursectomy was performed to allow for tear visualization. Participants were randomly assigned to one of two groups: 1) Cases: patients who received reimplantation of minced autologous bursa tissue to the surface of the rotator cuff repair at the completion of the repair, and 2) Controls: patients who underwent standard rotator cuff repair surgery. Pre-operative tear data was recorded, and clinical follow-up was conducted at 2 weeks, 6 week, 3 month, 6 months, 12 months, and 24 months. Self-reported outcomes were measured using the ASES, SST, and PROMIS questionnaires. At a minimum of 6 months after surgery, magnetic resonance imaging (MRI) was performed and evaluated using the Sugaya classification and measurements of supraspinatus tendon thickness. To compare self-reported outcomes, a repeated measure mixed-model analysis of variance (ANOVA) was conducted, with "Bursa" as the between-subjects factor and "Time" as the within-subjects factor. For the MRI results, differences in supraspinatus tendon thickness between the cohorts were analyzed using a Student’s t-test. The Sugaya classification scores were dichotomized into "not healed" (Score ≥4) and "healed" (Score ≤3), and the odds ratio of healing was compared between the groups. Statistical analyses were conducted at a significance level of α = 0.05, with a Bonferroni correction.Results:Sixty-seven patients (34% female) participated in the study. Baseline demographic details of the participants are provided in Table 1, and show no significant differences between groups. Self-reported Outcomes: Specifically, self-reported outcomes in study visits prior to 6 months showed better results in cases (Figure 1). However, the differences did not reach statistical significance, and the magnitude of differences was smaller than the MDC of the corresponding measures (ASES (Diff., MDC) = (3.2, 9-12), SST = (0.045, 2-3), and PROMIS = (2,3-4)). At follow up visits up to two years, clinical outcomes continued to improve in both groups, and were not significantly different (Figure 2). MR Outcomes: While the MRI outcomes did not reveal any statistically significant differences between the study groups, the odds of healing were slightly higher in the treatment group (86%) compared to the control group (83%). Moreover, the treatment group exhibited greater supraspinatus thickness (5.4±1.8 mm) than the control group (4.6±2.5 mm)(Figure 3).Conclusions:While not statistically significant, overall, the current results are encouraging as they could suggest that bursa augmentation could improve early outcomes after arthroscopic rotator cuff repair. However, given the findings’ non-significance, the practical use of such augmentation still needs to be determined. Given an encouraging trend in the data, future studies with larger sample sizes, longer follow-ups, and more objective and quantitative outcomes might be instrumental in detecting the potential benefits of this logically sound procedure, which could improve shoulder health and function long-term.

Response to Kooistra et al regarding: “The debate on rotator cuff surgery in the elderly continues!”