Sunday, January 14, 2018

Rotator cuff failure is often bilateral, acromioplasty may increase the risk of arthritis

Patients with a long-standing cuff tear in one shoulder have high rates of contralateral cuff tears: a study of patients with arthroscopically verified cuff tears 22 years ago

These authors identified 61 patients with 38 partial and 23 full-thickness tears of one shoulder at arthroscopy and examined them with bilateral radiographs, ultrasound, and the Constant-Murley score at a mean of 22 years (range, 21-25 years) after arthroscopy. 

The overall rate of full-thickness tears in the contralateral shoulder was 50.8%. 

With a full-thickness tear in the index shoulder, the frequency of contralateral full-thickness tears was even higher (71.8%).  The number of tendons with full-thickness tear involvement in 1 shoulder was a risk factor for having a contralateral cuff tear.

90% of the patients with CTA (defined as Hamada grade ≥ 2) had a contralateral full thickness tear.

20% of patients with CTA in the index shoulder also had arthropathy in the contralateral shoulder.

CTA changes were more common in patients with full-thickness tear and a previous acromioplasty (P < .001). 

They concluded that patients with long-standing cuff tears have high rates of contralateral cuff tears. The severity of the condition is strongly correlated between the shoulders. Patients with full-thickness tears and a previous acromioplasty had a significantly higher frequency of CTA than patients with cuff tears who had not undergone a previous acromioplasty. 

Comment: The multivariate analysis showed that the only significant factor for contralateral tear was the number of tendons with full thickness tears in the index shoulder at the time of followup. I.e. a bigger tear on one side predicted a tear on the other side. 

It would have been of interest to see a multivariate analysis of the potential factors associated with cuff tear arthropathy on the index and on the contralateral shoulders.

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