Sunday, February 19, 2012

Trends in Rotator Cuff Repair - JBJS

The February 2012 issue of the JBJS presents "National Trends in Rotator Cuff Repair" points to a 600% increase in the unadjusted number of arthroscopic rotator cuff repairs and a 34% increase in the number of open cuff repairs in the decade from 1996 to 2006.  The adjusted rate increases were 530% and 21% respectively. In their discussion the authors note that recent studies have failed to demonstrate a difference in functional outcome or complications between arthroscopic and open repairs and that arthroscopic repair has a 'steep learning curve'.

The reasons for this abrupt increase in arthroscopic cuff repairs are not clear. We know that there is increasing use of sophisticated imaging techniques such as contrast MRI or shoulder ultrasound that can reveal defects in the rotator cuff tendons, even when the shoulder is asymptomatic or minimally symptomatic. We know that each year more surgeons are trained in arthroscopic cuff repair and actively seek patients to whom this technology may be applied.

So what would be really important to know (but not knowable from this study) about the increased number of patients getting arthroscopic cuff repairs is (1) what were the indications for attempted repair of the cuff defect (other than 'because it's there)? (2) what were the acuity and sizes of the defects? and (3) what were the outcomes in terms of cuff integrity and improvement in comfort and function after cuff repair? Only with this information can we determine if this increase means that more patients are getting the care they need or if simply more patients are getting arthroscopic surgery on their rotator cuff.


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