Tuesday, October 4, 2016

In patients having bilateral cuff repairs, are the outcomes different between the two shoulders?

Functional outcomes after bilateral arthroscopic rotator cuff repair

These authors point out that many patients having a cuff tear on one side have similar pathology in the opposite shoulder. 

Arthroscopic view of cuff tear. 
Stump of torn tendon (red arrow), gap in cuff showing exposed humeral head (green arrow).

In a study comparing outcomes between the two shoulders having cuff repair, they found no significant difference in clinical outcomes when the shoulders were grouped by (a) arm dominance, (b) first vs second shoulder, and (c) tear size. Small or medium tears were present in 67 shoulders (63%), and 38 shoulders (36%) had large or massive tears. Shoulder dominance was not significantly associated with tear size.

12% of the repairs failed. Shoulders with intact cuffs by ultrasound had postoperative ASES scores averaging 86.2 with a range from 41.7 to 100, in comparison to the shoulders with retears, which had an average ASES score of 72.5 with a range from 43.3 to 100. This difference was not statistically significant (P = .2).

In their discussion the authors point out that healing after rotator cuff repair is extremely variable, with healing rates reported at 6% to 92% and that some studies demonstrate long-term well-preserved function despite tear recurrence.

Comment: These results are presented in terms of the clinical scores (ASES, SANE, Rowe) at the time of followup. It would have been of interest to compare these postoperative scores to preoperative scores documented for each shoulder before the surgery so that the improvement (i.e. the benefit) of the procedures could be assessed. This is particularly important because, as the authors point out, the shoulder opposite the one having cuff surgery is likely to have cuff a cuff tear, but the contralateral tear is often asymptomatic.

It is once again of interest to see how closely the postoperative functional results for retorn repairs resembles that of intact repairs.