These authors explored the trends over time and the geographical variation in the use of subacromial decompression and rotator cuff repair in 152 local health areas in England between 2000/2001 and 2009/2010.
The number of patients undergoing subacromial decompression alone rose by 746.4% from 5.2/100 000 to 40.2/100 000.
The authors point to a wide geographical range of rates of cuff repair ranging from 0 to 8/100,000 suggesting inconsistent application of indications for this surgery.
The discussion points out the inconclusive evidence supporting different surgical treatments of cuff diseases. For example they refer to a recent prospective randomized study comparing bursectomy to acromioplasty that found no difference in outcome.
The authors conclude that "Given the lack of evidence for the effectiveness of these operations and the significant increase in the number of procedures being performed in England and elsewhere, there is an urgent need for well-designed clinical trials to determine evidence of clinical effectiveness."
In this context, readers will be interested in this recent randomized study comparing non-operative management, acromioplasty and cuff repair in the treatment of non-traumatic cuff tears.
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Consultation for those who live a distance away from Seattle.
Click here to see the new Rotator Cuff Book
To see the topics covered in this Blog, click here
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