Treating the torn rotator cuff: current practice in the UK

Abstract

The aim of this study was to characterise current rotator cuff repair activity in the UK with emphasis on the management of rotator cuff tears in the elderly population (over 70s). A one-page web-based survey was created. All British Elbow and Shoulder Society (BESS) members and surgeons who listed the shoulder as an area of specialist interest on the website http://www.specialistInfo.com/ were invited to complete this. A total of 103 surgeons completed the survey; most (n =89, 86%) were BESS members. They had spent a median of 10 years (range: 9 months - 30 years) in consultant practice and performed an annual median of 200 (range: 0-1,000) arthroscopic shoulder procedures. For rotator cuff repair the favoured method was arthroscopic for 47 consultants (46.5%), open or mini-open for 41 (40.6%) and both for 13 (12.9%). The annual median number of arthroscopic and open cuff repairs was 20 (range: 0-250) and 12 (range: 0-100) respectively. The longer the time in practice, the fewer the reported number of arthroscopic cuff repairs (r(s)=-0.22, p=0.027) and the greater the number of open and mini-open cuff repairs (r(s)=0.33, p=0.001). In the management of a full-thickness rotator cuff tear in a patient over 70 years of age, 27 (26.7%) would perform an open or mini-open repair, 43 (42.6%) an arthroscopic repair and 22 (21.8%) would not attempt a repair. Surgeons performing a higher volume of arthroscopic cuff repairs annually were more likely to repair cuff tears and they predicted significantly better outcomes of cuff repair for both pain and shoulder movement. Our results reflect the existing conflicting evidence regarding the indications for and methods of treatment of rotator cuff disease.