Prior Rotator Cuff Repair Research Articles

Outcomes of Total Shoulder Arthroplasty With and Without Prior Rotator Cuff Repair: A Systematic Review.

The effect of prior rotator cuff repair (RCR) on clinical outcomes after total shoulder arthroplasty (TSA) is unclear. To systematically review the literature to compare the outcomes of TSA in patients with and without prior RCR. Systematic review; Level of evidence, 4. A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching the PubMed, Cochrane Library, and Embase databases to identify studies comparing outcomes of TSA with and without prior RCR. The inclusion criteria were full-text studies that directly compared outcomes between patients undergoing anatomic or reverse TSA with and without prior RCR. A quality assessment was performed using the Modified Coleman Methodology Score (MCMS), and risk of bias assessment was performed using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. A total of 1542 articles were identified for review based on initial database queries. Weighted means of quantifiable demographics and patient-reported outcomes were calculated for all included studies and compiled, in addition to the MCMS and ROBINS-I tool. Twelve studies (10 level 3, 2 level 4) met inclusion criteria, including a total of 885 patients who underwent RCR before TSA (mean age, 68.2 years) and 2275 patients with no prior RCR (mean age, 70.0 years). Of all outcomes evaluated, patients with reverse TSA showed superior results in the no prior RCR group. Three reverse TSA studies found the no prior RCR group to have significantly higher postoperative American Shoulder and Elbow Surgeons scores when compared with the prior RCR group (P < .05). Multiple reverse TSA studies found the no prior RCR group to have significantly higher postoperative Simple Shoulder Test scores (P < .05) and significantly improved forward elevation (P < .05) when compared with the prior RCR group. Of all outcomes in anatomic TSA studies, only complication rate was different between groups, with 1 study finding a significantly lower complication rate in the no prior RCR group (P = .01). Patients undergoing reverse TSA without prior RCR can be expected to experience statistically better outcomes when compared with patients with prior RCR, while patients undergoing anatomic TSA can be expected to have similar outcomes regardless of prior RCR status.

Poster 146: Higher Reoperation Rates Following Primary Rotator Cuff Repair in Patients Screening Positive for Depression

Objectives: Recent studies have identified an association between preoperative depression and worse outcomes following arthroscopic rotator cuff repair (RCR) surgery, including lower patient-reported outcomes, increased pain and impairment, and higher rates of complications. Patient Health Questionnaire-2 (PHQ-2) is a commonly administered screening tool for measuring depressive symptoms; however, the relationship between PHQ-2 and postoperative outcomes after RCR is not yet established. The purpose of this study is to investigate the association between depression and reoperation rates in patients undergoing primary RCR. Methods: This retrospective chart review evaluated data from all patients who underwent elective primary RCR at 1 health system between March 2016 and December 2021 and had a PHQ-2 score at least 6 months prior to their surgery. The PHQ-2 is a validated tool used to screen for depression with scores ranging from 0-6. Patients were categorized as either depressed (PHQ-2 ≥ 2) or nondepressed (PHQ-2 &lt; 2). Patients &lt;18 years old, history of prior RCR, and patients without PHQ-2 scores within 6 months of surgery were excluded from the study. The primary outcome was to compare reoperation rate, defined as the need for any subsequent surgery related to the primary RCR between depressed and non-depressed patients. The secondary outcome was a comparison of postoperative health care utilization, which included emergency department visits and hospital readmissions within 90 days. Depressed patients were also propensity matched 1:1 to nondepressed patients via age, body mass index (BMI), and tear size for a subanalysis. Results: A total of 238 patients who underwent primary RCR were included with 84 depressed patients and 154 nondepressed patients. Significantly more patients were female (67% versus 46%; P = 0.002) in the depressed cohort compared to nondepressed. There was a significantly increased incidence of comorbid depression (63% vs 28%; P &lt; 0.001), anxiety (52% vs 17%; P &lt; 0.001), and substance use disorder (20% vs 6%; P &lt; 0.001) as well as a lower median household income (MHI) in the depressed cohort versus the nondepressed cohort ($58,451.93 ± $21,024.93 vs. $66,751.93 ± $22,654.45; P &lt; 0.001). Fifteen (17.9%) depressed patients underwent reoperation versus 10 (6.5%) nondepressed patients (P = 0.006). Mean time to reoperation in the depressed cohort was 11.7 months (0.8-35 months). In the subanalysis, 80 patients in the depressed cohort and 80 patients in the nondepressed cohort were matched. Depressed patients had significantly higher rates of comorbid depression (63% vs 18%; P &lt; 0.001), anxiety (52% vs 17%; P &lt; 0.001), and substance use disorder (20% vs 6%; P &lt; 0.001) and a lower MHI ($58,615.20 ± $21,455.12 vs $66,470.73 ± $22,996.49; P = 0.04). Fewer patients were employed full time (22% vs. 44%) and more were disabled (30% vs 8%) amongst the depressed cohort (P = 0.003). Amongst depressed patients, 14 patients (17.5%) versus 4 (5%) underwent reoperation (P = 0.01). No significant differences in postoperative emergency department visits, postoperative complications, or hospital readmissions were found between the depressed and nondepressed cohorts in either analysis. Conclusions: We found patients screening positive for depression preoperatively, as measured by PHQ-2, had a significantly higher reoperation rate following primary RCR compared to nondepressed patients. These patients were more likely to be female, have comorbid mental health diagnoses, no full-time employment, and a lower household income. Screening for depression preoperatively could be a useful adjunct for providers to better identify patients at risk for worse outcomes.

Reverse shoulder arthroplasty following failed rotator cuff repair: A systematic review and meta-analysis

Background Reverse shoulder arthroplasty (RSA) is an established operative treatment for failed rotator cuff repair (RCR) that may not be amenable to revision repair. The purpose of this meta-analysis is to evaluate the clinical outcomes for patients undergoing RSA following prior failed RCR compared with patients without prior RCR undergoing primary RSA. Methods A systematic search of articles in Pubmed, EMBASE and The Cochrane Library databases was carried out according to PRISMA guidelines. Comparative studies assessing outcomes of RSA after failed RCR versus primary RSA were included. Results Seven studies with 2149 total patients were included; 760 patients had a prior RCR and 1389 patients did not have a prior RCR. Prior failed RCR resulted in significantly lower postoperative ASES scores (mean difference [MD], −8.31 95% confidence interval [CI] −10.96, −5.66), less forward flexion (MD, −6.71 95%CI −11.75, −1.67), and higher VAS pain scores (MD; 0.85, 95% CI 0.47, 1.22) when compared to primary RSA. There were no significant differences in external rotation, complications rate, or rate of revision. Conclusion This study found that failed RCR prior to RSA was associated with lower functional outcomes scores, higher pain scores, and worse range of motion compared to primary RSA without prior RCR.

Outcomes of total shoulder arthroplasty in patients with prior anterior shoulder instability: minimum 5-year follow-up

Patients with a history of anterior shoulder instability (ASI) commonly progress to glenohumeral arthritis or even "dislocation arthropathy" and often require total shoulder arthroplasty (TSA). The purposes of this study were to 1) report patient reported outcomes (PROs) after TSA in patients with a history of ASI, 2) compare TSA outcomes of those whose ASI was managed operatively versus those managed nonoperatively, and 3) report PROs of TSA in patients who previously underwent arthroscopic versus open ASI management. Patients were included if they had a history of ASI and were at least 5 years out from TSA performed by a single surgeon between 10/2005 and 01/2017. Exclusion criteria included prior rotator cuff repair, hemi-arthroplasty, or glenohumeral joint infection prior to index TSA. Patients were separated into two groups, those with previous operatively managed ASI and those whose ASI was treated nonoperatively. Prospectively collected demographic, surgical, and subjective data were retrospectively reviewed. PROs utilized were the ASES score, SANE, QuickDASH, SF-12 PCS. Failure was defined as revision TSA surgery, conversion to reverse TSA, or prosthetic joint infection. Kaplan-Meier survivorship analysis was performed. 36 patients (27 male, 9 female) with a mean age of 56.4 years (range, 18.8-72.2) were included. Patients in the operative ASI group were younger than those in the nonoperative ASI group (50.6 vs 64.0 years, p<.001). Operative ASI patients underwent 10 open and 11 arthroscopic anterior stabilization surgeries prior to their TSA (mean, 2; range, 1-4). 6 of 21 (28.6%) TSAs failed in patients with operative ASI while there were no failures in the nonoperative ASI group (p=0.03). Follow-up was obtained in 28 of 30 (93%) eligible patients at an average of 7.45 years (range, 5.0-13.6). In the collective cohort, ASES, SANE, QuickDASH, and SF-12 PCS scores significantly improved with no differences in the postoperative PROs between the two groups. No significant differences were found when comparing PROs between prior open and prior arthroscopic ASI procedures or when comparing the number of prior ASI procedures. Kaplan-Meier analysis demonstrated 79% 5-year survivorship in patients with prior ASI surgery and 100% survivorship in nonoperatively managed ASI patients (p=.030). At mid-term follow-up, patients with a history of prior ASI undergoing TSA can expect continued improvement in function compared to preoperative values. However, TSA survivorship is decreased in patients with a history of ASI surgery compared to those without prior surgery.

Anatomic Shoulder Arthroplasty in the Setting of Concurrent or Prior Rotator Cuff Repair: A Systematic Review.

Reverse total shoulder arthroplasty (RSA) is the gold standard in management of osteoarthritis (OA) in the setting of rotator cuff pathology. However, there are significant complications associated with the procedure. An alternative option in the setting of a deficient rotator cuff may be to perform a repair prior to or concurrently with an anatomic total shoulder arthroplasty (aTSA). A systematic review was performed utilizing Preferred Reporting Items for Systematic Meta-Analyses (PRISMA) guidelines to evaluate outcomes in aTSA with concomitant or prior rotator cuff repair (RCR). Key outcomes were complication rate and subjective outcome scores. Seven studies were included in the review. One study found a higher rate of total adverse events in the prior repair group (17% vs 7%, P = .01) while others found no significant difference. There was a nonstatistically significant increase in revision rates among patients with larger tears at time of repair. Prior repair groups were associated with a higher rate of re-tear in one study (13% vs 1%, P = .014). Concomitant repair was associated with a higher rate of loosening. In patients with prior repair, there was no statistical difference in strength, range of motion (ROM), simple shoulder test (SST), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and visual analogue scale (VAS). In patients with concurrent repair, one study demonstrated a less drastic improvement in Hospital for Special Surgery (HSS) in "moderate" repairs as opposed to "good" repairs. Anatomic TSA is an appropriate treatment for glenohumeral OA in patients with a prior successful RCR and in younger patients with concurrent repair of small or medium tears. Level III.

Postoperative Imaging of the Rotator Cuff: A Systematic Review and Meta-Analysis.

BACKGROUND. It is unclear which, MRI or ultrasound (US), is the most useful imaging tool to diagnose rotator cuff retears. OBJECTIVE. The objective of this study was to evaluate MRI and US in terms of diagnosing retear of a repaired rotator cuff tendon using a systematic review and meta-analysis. EVIDENCE ACQUISITION. A comprehensive literature search was performed on the main concepts of MRI (including noncontrast MRI and MR arthrography), US, and rotator cuff repairs. Inclusion criteria consisted of original research studies that assessed the diagnostic accuracy of MRI and US (index tests) for the diagnosis of rotator cuff tendon retear after prior rotator cuff repair using surgical findings as the reference standard. QUADAS-2 was used to assess methodologic quality. Meta-analyses were performed to compare MRI and US studies in the diagnosis of all retears and of full-thickness retears. Study variation was analyzed using the Cochran Q test and I2 statistic. EVIDENCE SYNTHESIS. Eight studies (MRI, n = 6; US, n = 2) satisfied inclusion and exclusion criteria, consisting of 304 total patients (MRI, n = 221; US, n = 83) and 309 shoulders (MRI, n = 226; US, n = 83). Years of publication ranged from 1993 to 2006 for the MRI studies and from 2003 to 2018 for the US studies. Two studies had high risk of bias in terms of applicability to clinical practice because of patient selection. Five studies had potential risk of bias in two categories, whereas two had potential risk of bias in three categories. For all retears, mean sensitivity and specificity for MRI were 81.4% (95% CI, 73.3-87.5%) and 82.6% (95% CI, 76.3-87.5%) and 83.7% (95% CI, 67.4-92.7%) and 90.7% (95% CI, 73.6-97.1%) for US. For full-thickness retears, mean sensitivity and specificity for MRI were 85.9% (95% CI, 80.2-90.2%) and 89.1% (95% CI, 84.6-92.4%) and 89.7% (95% CI, 75.6-96.1%) and 91.0% (95% CI, 75.5-97.1%) for US. There was no significant difference in terms of sensitivity or specificity for either comparison (p = .28-.76). CONCLUSION. Our analyses revealed no significant difference between US and MRI for the diagnosis of rotator cuff tendon tears after prior cuff repair. CLINICAL IMPACT. Either MRI or US can be considered a first-line imaging option to assess suspected rotator cuff retear after prior repair.

Poster 169: Prior Rotator Cuff Repair Is Not Associated with Worse Outcomes After Subsequent Superior Capsular Reconstruction: A Comparative Analysis

Objectives:To compare the outcomes of two patient cohorts: (1) primary SCR and (2) SCR after failed rotator cuff repair.Methods:A retrospective review was performed of all patients who had a SCR at our institution from 2015 to 2020. Data was collected for patient demographics, prior rotator cuff surgery, comorbidities, and preoperative and postoperative range of motion, strength testing, visual analog scale (VAS) pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS) 10 scores, American Shoulder and Elbow Surgeons (ASES) score, Brophy-Marx shoulder activity scale, and revision surgeries. Missing data points were excluded from analysis at that time point. Comparative analysis was used to assess for differences between patients that underwent an SCR only versus SCR after rotator cuff repair.Results:Fifty-four patients met inclusion criteria, consisting of 33 SCR only patients (61 ± 10 years, BMI 30 ± 6, 79% male) and 21 SCR after rotator cuff repair patients (59 ± 8 years, BMI 32 ± 5, 95% male). In the SCR only and SCR after rotator cuff repair groups, no significant difference was observed in age, BMI, gender, comorbidities, preoperative and postoperative range of motion, strength testing, VAS pain scores, PROMIS 10 scores, ASES score, Brophy-Marx shoulder activity scale, and revision surgeries (p>0.05).Conclusions:Similar outcomes were observed in patients who underwent primary SCR versus SCR after a failed rotator cuff repair, suggesting that surgeons should attempt to repair the rotator cuff at the index surgery if possible.

Poster 139: Outcomes After Arthroscopic Assisted Lower Trapezius Transfer: A Retrospective Study

Objectives:Massive irreparable rotator cuff tears lead to significant pain and disability. Tendon transfers have been described as one option to improve pain and function for patients, but clinical data are limited. The purpose of this study was to evaluate outcomes in patients after arthroscopically assisted lower trapezius tendon transfer (AALTT) for massive irreparable rotator cuff tears.Methods:Twenty-one patients with massive irreparable rotator cuff tears who underwent AALTT with a single surgeon from January 2017 to July 2021 were analyzed. Patient demographics such as age, sex, followup, worker’s compensation claims, and prior surgical history were recorded. Preoperative and one-year postoperative range of motion, external rotation strength, and pain visual analogue scale (VAS) were extracted from medical records. Patient reported outcomes measurements used for comparison included American Shoulder and Elbow Score (ASES), as well as Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function and Mental Function. Six-month postoperative MRIs were reviewed when available. Descriptive and univariate statistical analyses were performed.Results:The average patient age was 56.1 (range, 29-72) years and 19 patients (90.5%) were male. The average follow up was 13.2 (range, 4-45) months. Seven patients (33.3%) were involved in worker’s compensation claims and 17 patients (81%) had undergone prior rotator cuff repair. Out of 21 patients who were working at the time of surgery, eleven patients (52.4%) were able to return to their same occupation and 19 patients (86.4%) demonstrated complete tendon healing on postoperative MRI scans (Table 1). There was significant improvement in postoperative pain VAS (5.8±2 vs. 1.7±2) and ASES scores (44.3±18 vs. 71.6±23). No significant changes in PROMIS Physical (47.1±7 vs. 51.4±11) and PROMIS Mental (53.1±8 vs. 53.8±10) were observed. There were significant improvements in external rotation motion (11.0±17 degrees vs. 42.1±13 degrees) and strength (2.9/5 ±1 vs. 4.6/5 ±1) at final followup (Table 2).Conclusions:AALTT is a successful treatment option for the massive irreparable rotator cuff tear. Patients demonstrated significant improvements in pain, range of motion, and strength at one year, with complete tendon healing visualized on postoperative MRI scans.Table 1.AALTT Patient DemographicsTable 2.Ranee of Motion and Patient Reported Outcomes after AALTT

Concomitant Glenohumeral Instability and Rotator Cuff Injury: An Epidemiologic and Case-Control Analysis in Military Cadets.

Concomitant rotator cuff tear and glenohumeral instability in a large cohort of young and active patients has not been examined. The purpose of this study was to investigate the incidence, associated variables, and outcomes in military cadets undergoing shoulder stabilization procedures with these concomitant pathologies. A retrospective cohort study of a consecutive series of collegiate patients who underwent shoulder stabilization from 2014 to 2018 at a single service academy was conducted. Exclusion criteria were noncadets, revision instability cases, multidirectional instability, and prior rotator cuff repair. A nested case-control analysis was done in a matched series of patients with and without MRI evidence of rotator cuff tear. Baseline demographics, VAS pain scale, physical therapy duration, and time to surgery were analyzed. Postoperative metrics included rate of recurrent instability, subjective outcomes, VAS pain scale, and military-specific criteria. Three hundred twenty-four cadets met the inclusion criteria, including 272 men and 52 women averaging 20.53 ± 1.80 years of age. MRI demonstrated concomitant rotator cuff tears in 5.56% of cases. A matched case-control comparison between patients with (rotator cuff tear group) and without (no rotator cuff tear group) rotator cuff tear showed no differences in preoperative data, recurrent instability rate, or postoperative VAS pain scores (0.24 versus 0.88, P = 0.207) at mean 44-month follow-up. Fifteen of 17 patients (88.2%) in each group returned to full activity (P > 0.999). No patients failed to graduate due to shoulder concerns. No patients in the rotator cuff tear group underwent a medical board for separation from the military compared with 2 (11.8%) in the no rotator cuff tear group (P = 0.163). The incidence of concomitant rotator cuff tears in this study of military cadets undergoing shoulder stabilization was 5.56%. In a matched cohort comparison, the presence of a rotator cuff tear on preoperative MRI was not associated with inferior clinical outcomes.

Reverse shoulder arthroplasty for rotator cuff tears with and without prior failed rotator cuff repair: A large-scale comparative analysis

BackgroundLarge-scale data assessing the effect of a prior failed rotator cuff repair (RCR) on the outcome of reverse shoulder arthroplasty (RSA) is currently lacking. Therefore, this study aimed (1) to assess the course of patients undergoing RCR, specifically focusing on the need for conversion to RSA within two years, and (2) to compare outcomes following RSA performed for rotator cuff tears (RCTs) with and without prior RCR. MethodsThis retrospective cohort study included data from the CMS Data Set (2016–2018). For the first study objective, we included patients undergoing an RCR; these were followed for 24 months to identify a conversion to RSA. For the second study objective, we included RSAs for RCTs, stratified by those with and without a prior RCR (preceding 24 months). Outcomes (hospitalization cost, institutional post-acute care discharge, 90-day readmission and health resource utilization up to 6 months post-RSA) were compared between propensity score-matched groups. ResultsOut of 33,244 RCRs, 433 (1.3%) patients underwent RSA conversion within two years. Among 7534 RSA cases for RCTs, 245 (3.3%) had an RCR in the preceding two years. In the propensity score analysis, except for a minimal increase in the number of physical rehabilitation visits (RR 1.10; p = 0.0009), no differences were observed between those with and without prior RCR in terms of other RSA outcomes. These included hospitalization cost, discharge to institutional post-acute care facility, 90-day readmission and 6-month post-op cost ConclusionRotator cuff repair in elderly patients, when utilizing currently employed indication criteria, results in low conversion rates to RSA within 2 years postoperatively. Furthermore, large dataset outcomes after RSA for RCT such as cost, post-acute care discharge, physical rehabilitation, and readmission rates appear not to be negatively affected by the presence of a prior RCR. Level of evidenceLevel 3 evidence; Retrospective cohort study.

Outcomes of reverse shoulder arthroplasty following failed superior capsular reconstruction.

BackgroundHistory of prior rotator cuff repair (RCR) may adversely affect the outcomes of reverse total shoulder arthroplasty (RTSA), but there is no information regarding the influence of prior superior capsular reconstruction (SCR) surgery on the outcomes of RTSA. The purpose of this study is to evaluate the outcomes of RTSA following failed arthroscopic SCR.MethodsAll patients who underwent RTSA for failed SCR (SCR cohort) at our institution were identified from our institutional database. A comparative cohort of patients who had RTSA with a history of failed RCR (Control cohort) was also reviewed. Demographic information, 90-day complication rate, 90-day emergency department visits, length of stay, and outcome scores (patient-reported outcomes measurement information system [PROMIS] physical function upper extremity, Visual Analog Scale score, and range of motion) were compared.ResultsFrom 2015 to 2020, 87 arthroscopic SCRs were performed at our institution and of these, 13 patients underwent RTSA at a mean time of 14.6 months (5.8-32.4) after SCR and were followed up for an average of 17.9 months (1.6-44.6). The average number of shoulder surgeries prior to RTSA was 2.8 (1-7), with the last surgery being SCR. During the same period, we identified 15 patients who underwent an RTSA after a failed RCR (control cohort). The RTSA in the control cohort was performed on average at 12.8 months (1.5-39.5) following the last RCR, and patients were followed up for an average of 27.7 months (2.8-53.9). The average number of shoulder surgeries before the RTSA in the control cohort was 1.4 (1-3). Although the SCR cohort had significant improvements in pain scores and forward flexion (FF), there was only a modest functional improvement with PROMIS scores and no meaningful improvement with external rotation. Complications (23%) in the SCR cohort included 1 periprosthetic joint infection requiring 2-stage revision, 1 acromion stress fracture, and 1 ulnar neuritis. Overall, compared to the SCR cohort, patients in the control cohort had better function (PROMIS physical function upper extremity), lower Visual Analog Scale score, and greater range of motion (FF and external rotation) preoperatively and at last follow-up, but there were no differences in the length of stay and 90-day emergency department visits, infection, and complication rate between the 2 cohorts.ConclusionRTSA after failed SCR improves pain and FF but is associated with modest functional improvements and high complication rates. However, these findings will require confirmation in a larger cohort with longer follow-up.

Reverse Shoulder Arthroplasty After Prior Rotator Cuff Repair: A Matched Cohort Analysis.

Rotator cuff repair (RCR) is commonly performed before reverse shoulder arthroplasty (RSA) with conflicting evidence on the effect on arthroplasty outcomes. The purpose of this investigation was to evaluate the effect of a prior RCR on the outcomes and complications of primary RSA. Between 2007 and 2017, 438 RSAs performed in patients with a prior RCR and 876 case-matched controls were identified from a multicenter database. Patients were grouped based on a preoperative diagnosis of glenohumeral osteoarthritis (GHOA) and rotator cuff tear arthropathy (CTA). Data collected included range of motion, strength, complications, and revisions. Additional clinical metrics included American Shoulder and Elbow Society score, Constant score, Shoulder Pain and Disability Index, Simple Shoulder Test, and the University of California Los Angeles shoulder score. Compared with controls, both GHOA and CTA study groups demonstrated lower postoperative forward elevation (FE) (133° versus 147°, P < 0.001; 133° versus 139°, P = 0.048) and FE trength (6.5 versus 8.2, P = 0.004; 6.1 versus 7.3, P = 0.014). In addition, inferior improvements were observed in the GHOA and CTA study groups with respect to abduction (38° versus 52°, P = 0.001; 36° versus 49°, P = 0.001), FE (41° versus 60°, P < 0.001; 38° versus 52°, P = 0.001), ER (16° versus 25°, P < 0.001; 10° versus 17°, P = 0.001), and Constant score (28.4 versus 37.1, P < 0.001; 26.2 versus 30.9, P = 0.016). Compared with controls, no differences were observed in the GHOA and CTA study groups with respect to notching (11.2% versus 5.6%, P = 0.115; 5.8% versus 7.9%, P = 0.967), complications (4.3% versus 1.6%, P = 0.073; 2.5% versus 2.7%, P = 0.878), and revision surgery (3.1% versus 0.9%, P = 0.089; 1.1% versus 1.3%, P = 0.822). RSA after a prior RCR improves both pain and function, without increasing scapular notching, complications, or revision surgery. However, compared with patients without a prior RCR, postoperative shoulder function may be slightly decreased. III; Retrospective Cohort Study.

Failed prior rotator cuff repair is associated with worse clinical outcomes after reverse total shoulder arthroplasty

BackgroundThe purpose of this study is to determine the comparative risk profile and clinical outcomes for patients undergoing reverse total shoulder arthroplasty (RTSA) for cuff tear arthropathy (CTA) without failed prior rotator cuff repair (RCR) compared with RTSA for CTA with prior RCR. MethodsFrom 2006 to 2014, all patients who underwent RTSA by two surgeons after failed RCR with minimum 2-year follow-up were identified. Patients who underwent RTSA with failed prior RCR were matched in a 1:1 ratio to patients undergoing primary RTSA, while controlling for demographic factors, prosthesis design, and surgeon. Postoperative active forward elevation and active external rotation were recorded. Outcome measures included American Shoulder and Elbow Surgeons score, Visual Analog Scale (VAS), and Simple Shoulder Test. Perioperative complications and rates of secondary reoperation were noted, and comparative multivariate analysis was performed. ResultsOf 262 patients, 192 (73.3%) were available at minimum 2-year follow-up. The prior RCR group had a significantly higher complication rate (17.4%, n = 15) than the primary RTSA group (3.8%, n = 4) (P = .001), although no significant difference in periprosthetic infection (P = .469) or secondary revision rate (P = .136) was observed. At mean 36.3 ± 26.1-month follow-up, the prior RCR group had statistically worse American Shoulder and Elbow Surgeons score (P < .001), VAS (P = .001), Simple Shoulder Test (P < .001), and active forward elevation (P = .006). Patients with multiple failed RCR attempts (n = 38) before RTSA demonstrated no significant differences versus isolated failed RCR (n = 48; P > .05). ConclusionThis study demonstrated that patients with RTSA after prior failed RCR have significantly worse patient-reported outcomes and greater rate of perioperative complications than patients undergoing primary RTSA for CTA.

Mid-term outcomes after reverse total shoulder arthroplasty with latissimus dorsi transfer.

Reverse total shoulder arthroplasty is a common treatment for patients with rotator cuff arthropathy who have failed a prior rotator cuff repair. Latissimus dorsi transfer can be performed simultaneously to reverse total shoulder arthroplasty for patients with preoperative external rotation deficiency. Current literature is limited with several studies providing functional and pain improvements at short-term follow-up; however, there is a deficit in data regarding mid-term outcomes. The purpose of this study was to evaluate the clinical and radiographic outcomes following reverse total shoulder arthroplasty with latissimus dorsi transfer with mid-term follow-up. We hypothesized significant improvement in external rotation and shoulder functionality for patients with preoperative external rotation lag. We retrospectively reviewed patients who underwent reverse total shoulder arthroplasty with latissimus dorsi transfer. Preoperative and postoperative changes in range of motion were assessed. American Shoulder and Elbow Surgeon Score and the Simple Shoulder Test were used to evaluate changes in shoulder function while pain scores were assessed using the Visual Analog Scale (VAS). Radiographs were reviewed for rotator cuff arthropathy, fatty infiltration, scapular notching, baseplate loosening, and osteolysis. We reported frequency and mean ± standard deviation for categorical and continuous variables, respectively. Means were compared using the paired Student's t-test and proportions using the Chi-square test. Fifteen patients met the inclusion criteria. The mean age of the cohort was 71.7 ± 8.4 years (range 51.2-87.8 years) with a mean follow-up of 6.3 ± 4.1 years (range 1.0-14.5 years). Reverse total shoulder arthroplasty with latissimus dorsi transfer improved external rotation (-7 ± 21.3° to 38 ± 15.8°; p value = 0.001). There was no statistically significant difference regarding forward flexion (116.3 ± 45.4° to 133.7 ± 14.7°; p value = 0.17) and internal rotation (T12 to L2; p value = 0.57). The procedure led to an increase in American Shoulder and Elbow Surgeon Score scores (37 ± 19 to 62 ± 22; p = 0.005) and Simple Shoulder Test scores (2 ± 2 to 6 ± 3; p value = 0.001) with a significant reduction in Visual Analog Scale scores (5 ± 3 to 2 ± 3; p value = 0.022). The procedure corrected external rotation lag in 10 patients. Radiographically, rotator cuff arthropathy was found to be grade 3 in two patients, grade 4 A in four patients, grade 4B in eight patients, and grade 5 in one patient. On postoperative imaging, scapular notching was found in six patients (40%). Twelve patients had cortical humeral erosion at the site of the latissimus dorsi transfer. Only one patient experienced a shoulder-related complication which was aseptic baseplate loosening and required a revision reverse total shoulder arthroplasty with allograft. In this study, patients undergoing reverse total shoulder arthroplasty with latissimus dorsi transfer experienced improvements in range of motion, functional scores, and pain at mid-term follow-up. The shoulder-related complication rate was low.Level of evidence: IV; Case series.

Anatomic total shoulder arthroplasty after healed rotator cuff repair: a matched cohort

Rotator cuff tears are a common cause of failure after anatomic total shoulder arthroplasty (TSA). The purpose of this study was to evaluate the effect of a healed prior rotator cuff repair (RCR) on outcomes and complications after primary TSA. We hypothesized that patients with a prior healed RCR would have equivalent outcomes and complication rates compared with patients without prior surgery. A retrospective review of all primary TSAs with a prior RCR was performed using a multicenter database between 2005 and 2017. Thirty shoulders with prior RCR were case matched on a 3:1 ratio with a minimum 2-year follow-up. Range of motion, strength, patient-reported outcomemeasures, complications, and reoperations were compared. Thirty shoulders with a prior RCR were compared with 90 control patients without prior surgery at a mean follow-up of 43 months (range, 24-109 months). Groups demonstrated similar preoperative range of motion and patient-reported outcome measures. Postoperatively, TSAs with a prior healed RCR demonstrated less forward flexion (132° vs. 143°, P = .14) and strength (5.7vs. 6.4 kg, P = .55) compared with control shoulders with no prior surgery; however, these did not meet statistical significance. Complications were significantly more common in patients with a prior RCR (17% vs. 7%, P = .01). Postoperative rotator cuff tears were significantly more common in TSA with a healed prior RCR (13% vs. 1%, P = .014). TSA after RCR results in similar functional improvements compared with shoulders without prior surgery. However, the risk of a postoperative rotator cuff tear is significantly higher after prior successful RCR. Surgeons should consider this potential complication when indicating these patients for primary TSA.

Une réparation préalable de la coiffe des rotateurs affecte-t-elle les résultats de l’arthroplastie inversée de l’épaule ? Étude cas-témoins

BackgroundThis study compares outcomes of reverse total shoulder arthroplasty (RTSA) in patients with prior rotator cuff repair to matched control patients without prior surgery. Patients and methodsAll primary RTSAs with prior surgery were retrospectively identified from a prospective research database between 2000 and 2014. RTSA patients with prior open or arthroscopic rotator cuff repair and minimum 2-year follow-up, with age- and sex-matched controls, were identified. Active range of motion (ROM) and functional outcomes were evaluated. Preoperative, postoperative and improvement in outcomes were compared between groups. ResultsOne hundred fifty RTSA patients were included, with 75 patients in each group (42 female, 33 male). Mean age of the RTSA group with prior rotator cuff repair was 69.6 years (average follow-up, 3.8 years) compared to the RTSA group without prior surgery (control) aged 70.0 years (average follow-up, 3.3 years). Preoperatively and postoperatively, RTSA patients with prior cuff repair had slightly worse overhead ROM and outcome scores compared to controls but none were statistically different. The RTSA and control groups had similar and significant improvements in all postoperative ROM and outcome scores. Complications were similar between groups. DiscussionRTSA patients with prior rotator cuff repair had similar ROM, functional outcome scores, and complications compared to a matched control group without prior surgery. Level of EvidenceIII, Treatment Study.

Does having prior rotator cuff repair affect outcomes in reverse shoulder arthroplasty? A matched cohort study

BackgroundThis study compares outcomes of reverse total shoulder arthroplasty (RTSA) in patients with prior rotator cuff repair to matched control patients without prior surgery. Patients and methodsAll primary RTSAs with prior surgery were retrospectively identified from a prospective research database between 2000 and 2014. RTSA patients with prior open or arthroscopic rotator cuff repair and minimum 2-year follow-up, with age- and sex-matched controls, were identified. Active range of motion (ROM) and functional outcomes were evaluated. Preoperative, postoperative, and improvement in outcomes were compared between groups. ResultsOne hundred fifty RTSA patients were included, with 75 patients in each group (42 female, 33 male). Mean age of the RTSA group with prior rotator cuff repair was 69.6years (average follow-up: 3.8years) compared to the RTSA group without prior surgery (control) aged 70.0years (average follow-up: 3.3years). Preoperatively and postoperatively, RTSA patients with prior cuff repair had slightly worse overhead ROM and outcome scores compared to controls but none were statistically different. The RTSA and control groups had similar and significant improvements in all postoperative ROM and outcome scores. Complications were similar between groups. DiscussionRTSA patients with prior rotator cuff repair had similar ROM, functional outcome scores, and complications compared to a matched control group without prior surgery. Level of evidenceIII, treatment study.

Significant improvement in patient self-assessed comfort and function at six weeks after the smooth and move procedure for shoulders with irreparable rotator cuff tears and retained active elevation.

It has been documented that the smooth and move procedure-smoothing the proximal humeral surface while maintaining the coracoacromial arch-can provide clinically significant long-term improvement in function for patients having irreparable rotator cuff tears with retained active elevation. This study sought to demonstrate that clinically significant gains in comfort, function, and active motion can be realized as early as 6weeks after this procedure. We conducted a prospective cohort study of the 6-week clinical outcomes for 48 patients enrolled prior to a smooth and move procedure for irreparable rotator cuff tears. Prior rotator cuff repair had been attempted in 28 (70%). In 40 patients with preoperative and 6-week postoperative measurements, the Simple Shoulder Test scores improved from an average of 3.4 ± 2.8 preoperatively to 5.7 ± 3.5 at 6weeks (p < 0.001), an improvement that exceeded the published values for the minimal clinically important difference (MCID). The clinical outcomes were not worse for the 18 shoulders with irreparable tears of both the supraspinatus and infraspinatus. In 30 patients with preoperative and 6-week postoperative objective measurements of active motion, the average abduction improved from 93(± 43) to 123(± 47)° (p = 0.005) and the average flexion improved from 102(± 46) to 126(± 44)° (p = 0.023). In addition to its previously documented long-term effectiveness for shoulders with irreparable rotator cuff tears and retained active elevation, this study demonstrates that the smooth and move procedure provides clinically significant improvement as early as 6weeks after surgery.

Failed Prior Rotator Cuff Repair Is Associated With Worse Clinical Outcomes After Reverse Shoulder Arthroplasty

To determine the comparative risk profile and clinical outcomes for patients undergoing reverse total shoulder arthroplasty (RTSA) for cuff tear arthropathy (CTA) with or without failed prior rotator cuff repair (RCR).

Outcomes of arthroscopic revision rotator cuff repair with acellular human dermal matrix allograft augmentation

The purpose was to assess the minimum 2-year patient-reported outcomes and failure rate of patients who underwent revision arthroscopic rotator cuff repair augmented with acellular human dermal matrix (AHDM) allograft for repairable retears. From 2008-2014, patients who underwent revision rotator cuff repair augmented with AHDM with greater than 2 years' follow-up by a single surgeon were retrospectively reviewed. Data regarding surgical history, demographic characteristics, and medical comorbidities were collected. Outcome data included American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores, as well as rotator cuff healing on magnetic resonance imaging or ultrasound. Retears and subsequent surgical procedures were characterized. A total of 28 patients met our inclusion criteria, and 23 (82%) were available for follow-up at 2 years. The mean age was 60.1 ± 9.3 years (range, 43-79 years), with a mean follow-up period of 48 ± 23 months. All patients had at least 1 prior rotator cuff repair. Of the 23 patients, 13 (56%) underwent postoperative imaging, and 4 of these 13 (31%) had a retear. A reoperation was performed in 3 of 23 patients (13%). Among the 6 patients with both preoperative and postoperative outcome scores, we saw improvement in the ASES score from 56 to 85 (P = .03) and in the SANE score from 42 to 76 (P = .03). The full cohort's mean postoperative ASES and SANE scores were 77 and 69, respectively. AHDM allograft augmentation is a safe and effective treatment method for patients with full-thickness rotator cuff retears. Further research is needed with larger studies to confirm these findings from our small cohort of patients.