Thursday, February 4, 2016

"Expert' rotator cuff surgeons, what do they say about rotator cuff surgery?

A Survey of Expert Opinion Regarding Rotator Cuff Repair.

Rotator cuff tears are a common shoulder problem among people older than sixty years of age. The American Academy of Orthopaedic Surgeons published clinical practice guidelines for optimizing the treatment of rotator cuff problems based on a systematic review of the current literature (see this link). However, many of those recommendations were inconclusive because of the lack of high-level evidence. The purpose of this study was to determine common clinical practices among 372 members of the American Shoulder and Elbow Surgeons and the Association of Clinical Elbow and Shoulder Surgeons  regarding rotator cuff repair. 111 surgeons (29.8%) completed all or part of the survey.


There are some interesting aspects of the results of the survey. Among them:

(1)  91% of the respondents report operating on patients who are smoking in spite of the evidence that smoking is associated with an increase rate of cuff tear and repair failure.

(2) 87% of the shoulder surgeons did not routinely use an imaging modality to assess healing of their rotator cuff repairs, yet the respondents felt comfortable quoting healing rates of 80-90% for tears < 2 cm, 70-80% for tears 2-4 cm, and 50-60% for tears >5 cm; this is in spite of the fact that these healing rates are higher than those reported by high quality studies in which post operative imaging was carried out.

(3) the majority of respondents allow their patients on Worker’s compensation to return to work at 6 months after rotator cuff surgery, a delay substantially longer that that used in a recent study (see this link) that assumed that workers lost an average of only twenty-eight additional days as a result of rotator cuff repair compared with those undergoing nonoperative treatments.

(4) A consensus response (>50% agreement) was achieved on only 24 of 49  (49%) of the questions. 

As pointed out recently (see this link), better evidence on the factors affecting the outcomes of the treatment of rotator cuff tears will require that we do a better job of collecting the data that are available.

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