Rotator cuff retear after repair surgery: comparison between experienced and inexperienced surgeons

Background: We hypothesized in this study that the characteristics of retear cases vary according to surgeon volume and that surgical outcomes differ between primary and revision arthroscopic rotator cuff repair (revisional ARCR).Methods: Surgeons performing more than 12 rotator cuff repairs (RCRs) per year were defined as high-volume surgeons, and those performing fewer than 12 RCRs were considered low-volume surgeons. Of the 47 patients who underwent revisional ARCR at our clinic enrolled in this study, 21 cases were treated by high-volume surgeons and 26 cases by low-volume surgeons. In all cases, the interval between primary surgery and revisional ARCR, degree of “acromial scuffing,” number of anchors, RCR technique, retear pattern, fatty infiltration, retear size, operating time, and clinical outcome were recorded.Results: During primary surgery, significantly more lateral anchors (p=0.004) were used, and the rate of use of the double-row repair technique was significantly higher (p<0.001) in the high- versus low-volume surgeon group. Moreover, the “cut-through pattern” was observed significantly more frequently among the cases treated by high- versus low-volume surgeons (p=0.008). The clinical outcomes after revisional ARCR were not different between the two groups.Conclusions: Double-row repair during primary surgery and the cut-through pattern during revisional ARCR were more frequent in the high- versus low-volume surgeon groups. However, no differences in retear site or size, fatty infiltration grade, or outcomes were observed between the groups.

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Arthroscopic Rotator Cuff Repair in 2019: Linked, Double Row Repair for Achieving Higher Healing Rates and Optimal Clinical Outcomes

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2019.02.048 ◽

2019 ◽

Vol 35 (9) ◽

pp. 2749-2755 ◽

Cited By ~ 6

Author(s):

Andrew J. Sheean ◽

Robert U. Hartzler ◽

Stephen S. Burkhart

Keyword(s):

Rotator Cuff ◽

Clinical Outcomes ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Double Row ◽

Arthroscopic Rotator Cuff ◽

Double Row Repair ◽

Cuff Repair

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Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119850503 ◽

2019 ◽

Vol 7 (6) ◽

pp. 232596711985050 ◽

Cited By ~ 6

Author(s):

Lambert Li ◽

Steven L. Bokshan ◽

Shayna R. Mehta ◽

Brett D. Owens

Keyword(s):

Rotator Cuff ◽

Low Income ◽

Rotator Cuff Repair ◽

Univariate Analysis ◽

High Volume ◽

Arthroscopic Rotator Cuff Repair ◽

Distal Clavicle ◽

Low Volume ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Surgeon caseload has been shown to affect both health and economic outcomes in arthroscopic rotator cuff repair. Although previous studies have investigated disparities in access to care, little is known about disparities between low- and high-volume surgeons and facilities. Purpose: To identify where disparities may exist regarding access to high-volume surgeons and facilities. Study Design: Cross-sectional study. Methods: Univariate analysis was performed to analyze differences in the caseload between low- and high-volume surgeons and facilities. Cutoff values were set at 50 cases per year for high-volume surgeons and 125 cases annually for high-volume facilities. Multiple linear regression was then used to develop a cost model incorporating all variables significant under univariate analysis. We collected 18,616 cases with Current Procedural Terminology code 29827 (“arthroscopic rotator cuff repair”) from the 2014 Florida State Ambulatory Surgery and Services Databases. Results: A greater proportion of the caseload for low-volume surgeons and facilities was composed of patients who were of lower socioeconomic status, had government-subsidized insurance, or lived in areas with low-income ZIP codes. Low-volume surgeons and facilities also had higher total charges, higher postoperative admission rates, and lower distal clavicle excision rates ( P < .001). In our cost model, a low facility volume significantly increased costs. Subacromial decompression, postoperative admission, distal clavicle excision, male sex, and government-subsidized insurance were all significant factors for increased costs in multivariate cost analysis. Conclusion: There are disparities in access to high-volume surgeons and facilities for patients undergoing arthroscopic rotator cuff repair in Florida. Patients with a lower socioeconomic status, government-subsidized insurance, and low income all faced decreased access to these high-volume groups. High-volume surgeons and facilities were associated with lower total charges, higher rates of distal clavicle excision, and lower readmission rates. Low-volume facilities added a significant amount of cost, even when controlling for all other significant variables. It is important for providers to be aware of these disparities and work to address them in their own practices.

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Arthroscopic Single-Row versus Double-Row Suture Anchor Rotator Cuff Repair

The American Journal of Sports Medicine ◽

10.1177/0363546505279575 ◽

2005 ◽

Vol 33 (12) ◽

pp. 1861-1868 ◽

Cited By ~ 292

Author(s):

Augustus D. Mazzocca ◽

Peter J. Millett ◽

Carlos A. Guanche ◽

Stephen A. Santangelo ◽

Robert A. Arciero

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Double Row ◽

Single Row ◽

Load To Failure ◽

Arthroscopic Rotator Cuff ◽

Double Row Repair ◽

Cuff Repair ◽

Repair Techniques

Background Recurrent defects after open and arthroscopic rotator cuff repair are common. Double-row repair techniques may improve initial fixation and quality of rotator cuff repair. Purpose To evaluate the load to failure, cyclic displacement, and anatomical footprint of 4 arthroscopic rotator cuff repair techniques. Hypothesis Double-row suture anchor repair would have superior structural properties and would create a larger footprint compared to single-row repair. Study Design Controlled laboratory study. Methods Twenty fresh-frozen cadaveric shoulders were randomly assigned to 4 arthroscopic repair techniques. The repair was performed as either a single-row technique or 1 of 3 double-row techniques: diamond, mattress double anchor, or modified mattress double anchor. Angle of loading, anchor type, bone mineral density, anchor distribution, angle of anchor insertion, arthroscopic technique, and suture type and size were all controlled. Footprint length and width were quantified before and after repair. Displacement with cyclic loading and load to failure were determined. Results There were no differences in load to failure and displacement with cyclic loading between the single-row repair and each double-row repair. All repair groups demonstrated load to failure greater than 250 N. A significantly greater supraspinatus footprint width was seen with double-row techniques compared to single-row repair. Conclusions The single-row repair technique was similar to the double-row techniques in load to failure, cyclic displacement, and gap formation. The double-row anchor repairs consistently restored a larger footprint than did the single-row method. Clinical Relevance The arthroscopic techniques studied have strong structural properties that approached the reported performance of open repair techniques. Double-row techniques provide a larger footprint width; although not addressed by this study, such a factor may improve the biological quality of repair.

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