Saturday, April 16, 2016

Bilateral rotator cuff repair - are the results comparable?

Functional outcomes after bilateral arthroscopic rotator cuff repair

These authors proposed to determine if there are clinical differences in shoulders of patients who underwent staged bilateral rotator cuff repairs during their lifetime.

They retrospectively reviewed patients who underwent staged bilateral arthroscopic rotator cuff surgery with at least 2 years of follow-up.

Of 81 patients eligible, they were able to obtain questionnaire data from 55 (68%) through either phone call or in person evaluation. Thirty-eight patients (69% of enrolled patients) participated by phone call only. Seventeen patients  (31% of enrolled patients) had followup ultrasound to evaluate cuff integrity. 12% of these shoulders did not show complete healing. 

Followup ASES scores varied quite widely averaging 86.5 (36.7-100) in the dominant shoulder compared with 89.6 (23.3-100) in the nondominant shoulder (P = .42).

Comment: A challenge in such a study is to control for the length of followup in comparing two shoulders in the same individuals, recognizing that longer followup is associated with increasing retear rates and decreasing shoulder function. This is best done with a multivariate analysis of the factors associated with postoperative shoulder function in which time after surgery is included as a variable along with tear size, side, preoperative shoulder function, dominance, and date of surgery. However, this type of analysis requires a substantially greater sample size than that presented here.

Patients having bilateral cuff repairs provide an interesting opportunity to compare (1) the first and second side, (2) right vs left, and  (3) dominant vs non-dominant with respect to clinical outcome and retear rate. 

An effective way to make this comparison is with a scatter plot that would enables the reader to see how the variation among patients compares to the variation between shoulders. Here's a hypothetical example showing that the results for the dominant and non dominant shoulders of each patient are more similar than the results among patients. If these were real data, they would suggest that we could inform patients that the result they achieved on one side is likely to be similar to that on the other.

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