Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty

Abrams, Geoffrey D.; Gupta, Anil K.; Hussey, Kristen; Tetteh, Elizabeth S.; Karas, Vasili; Bach, Bernard R.; Cole, Brian J.; Romeo, Anthony A.; Verma, Nikhil N.

doi:10.1177/0363546514529091

Cited by 108 publications

(127 citation statements)

References 22 publications

Supporting

Mentioning

126

Contrasting

Order By: Relevance

“…Six RCTs 26,[52][53][54][55][56] comparing a surgical intervention with another surgical intervention were identified ( Table 1). Of these six trials, one RCT 56 is ongoing, with completed recruitment but final results awaiting publication.…”

Section: Surgery Compared With Surgerymentioning

confidence: 99%

“…Four RCTs included participants with full-thickness rotator cuff tears 26,52,54,55 and one included participants with small and medium rotator cuff tears. 53 The type of surgical interventions differed between trials, with one RCT comparing arthroscopic repair with mini-open repair, 53 one comparing mini-open repair arthroscopic acromioplasty with open surgical repair 55 and three comparing arthroscopic with acromioplasty repair with arthroscopic without acromioplasty repair.…”

Section: Surgery Compared With Surgerymentioning

confidence: 99%

“…53 The type of surgical interventions differed between trials, with one RCT comparing arthroscopic repair with mini-open repair, 53 one comparing mini-open repair arthroscopic acromioplasty with open surgical repair 55 and three comparing arthroscopic with acromioplasty repair with arthroscopic without acromioplasty repair. 26,52,54 The choice of primary outcome also varied across studies and included pain, disability or function measured using shoulder-specific instruments. Four 26,52,54,55 of the five completed RCTs reported blinded assessment of these outcomes.…”

Section: Surgery Compared With Surgerymentioning

confidence: 99%

“…26,52,54 The choice of primary outcome also varied across studies and included pain, disability or function measured using shoulder-specific instruments. Four 26,52,54,55 of the five completed RCTs reported blinded assessment of these outcomes. Overall, no RCT showed a statistically significant difference between the two types of surgical intervention being compared.…”

Section: Surgery Compared With Surgerymentioning

confidence: 99%

See 3 more Smart Citations

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

Carr

Cooper

Campbell

et al. 2015

Health Technol Assess

111

View full text Add to dashboard Cite

BackgroundUncertainty exists regarding the best management of patients with degenerative tears of the rotator cuff.ObjectiveTo evaluate the clinical effectiveness and cost-effectiveness of arthroscopic and open rotator cuff repair in patients aged ≥ 50 years with degenerative rotator cuff tendon tears.DesignTwo parallel-group randomised controlled trial.SettingNineteen teaching and district general hospitals in the UK.ParticipantsPatients (n = 273) aged ≥ 50 years with degenerative rotator cuff tendon tears.InterventionsArthroscopic surgery and open rotator cuff repair, with surgeons using their usual and preferred method of arthroscopic or open repair. Follow-up was by telephone questionnaire at 2 and 8 weeks after surgery and by postal questionnaire at 8, 12 and 24 months after randomisation.Main outcome measuresThe Oxford Shoulder Score (OSS) at 24 months was the primary outcome measure. Magnetic resonance imaging evaluation of the shoulder was made at 12 months after surgery to assess the integrity of the repair.ResultsThe mean OSS improved from 26.3 [standard deviation (SD) 8.2] at baseline to 41.7 (SD 7.9) at 24 months for arthroscopic surgery and from 25.0 (SD 8.0) at baseline to 41.5 (SD 7.9) at 24 months for open surgery. When effect sizes are shown for the intervention, a negative sign indicates that an open procedure is favoured. For the intention-to-treat analysis, there was no statistical difference between the groups, the difference in OSS score at 24 months was –0.76 [95% confidence interval (CI) –2.75 to 1.22;p = 0.452] and the CI excluded the predetermined clinically important difference in the OSS of 3 points. There was also no statistical difference when the groups were compared per protocol (difference in OSS score –0.46, 95% CI –5.30 to 4.39;p = 0.854). The questionnaire response rate was > 86%. At 8 months, 77% of participants reported that shoulder problems were much or slightly better, and at 24 months this increased to 85%. There were no significant differences in mean cost between the arthroscopic group and the open repair group for any of the component resource-use categories, nor for the total follow-up costs at 24 months. The overall treatment cost at 2 years was £2567 (SD £176) for arthroscopic surgery and £2699 (SD £149) for open surgery, according to intention-to-treat analysis. For the per-protocol analysis there was a significant difference in total initial procedure-related costs between the arthroscopic group and the open repair group, with arthroscopic repair being more costly by £371 (95% CI £135 to £607). Total quality-adjusted life-years accrued at 24 months averaged 1.34 (SD 0.05) in the arthroscopic repair group and 1.35 (SD 0.05) in the open repair group, a non-significant difference of 0.01 (95% CI –0.11 to 0.10). The rate of re-tear was not significantly different across the randomised groups (46.4% and 38.6% for arthroscopic and open surgery, respectively). The participants with tears that were impossible to repair had the lowest OSSs, the participants with re-tears had slightly higher OSSs and the participants with healed repairs had the most improved OSSs. These findings were the same when analysed per protocol.ConclusionIn patients aged > 50 years with a degenerative rotator cuff tear there is no difference in clinical effectiveness or cost-effectiveness between open repair and arthroscopic repair at 2 years for the primary outcome (OSS) and all other prespecified secondary outcomes. Future work should explore new methods to improve tendon healing and reduce the high rate of re-tears observed in this trial.Trial registrationCurrent Controlled Trials ISRCTN97804283.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 80. See the NIHR Journals Library website for further project information.

show abstract

Section: Surgery Compared With Surgerymentioning

confidence: 99%

Section: Surgery Compared With Surgerymentioning

confidence: 99%

Section: Surgery Compared With Surgerymentioning

confidence: 99%

Section: Surgery Compared With Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

Carr

Cooper

Campbell

et al. 2015

Health Technol Assess

111

View full text Add to dashboard Cite

show abstract

“…Multiple Level 1 and 2 studies published recently comparing arthroscopic RCR with and without "traditional" acromioplasty (coracoacromial ligament release and anterior acromial resection) have shown no difference in functional or patient reported outcomes or re-tear rates [34][35][36].…”

Section: Acromioplastymentioning

confidence: 97%

Partial and Full-Thickness RCT: Modern Repair Techniques

Nathani

Smith

Wang

2018

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

Purpose of Review The purpose of this article is to review the recent literature concerning modern repair techniques related to partial-and full-thickness rotator cuff tears. Recent Findings The understanding of rotator cuff pathology and healing continues to evolve, beginning with emerging descriptions of the anatomic footprint and natural history of rotator cuff tears. Significant controversy remains in treatment indications for partial-thickness rotator cuff lesions as well as optimal surgical repair techniques for both partial-and full-thickness tears. Techniques such as margin convergence and reduction of the so-called "comma" tissue have improved the ability to anatomically reduce large and retracted tears. Repair strength and contact pressures are improved with double-row repairs and transosseusequivalent techniques compared to traditional single-row repairs. Future work is directed towards obtaining reliable radiographic healing and demonstrating clinical superiority and cost-effectiveness of a single technique. Summary Much recent work regarding rotator cuff anatomy and pathology has been reported. Newer techniques improve repair strength. Despite these advances, significant questions remain concerning surgical indications and clinical outcomes.

show abstract

Surgery for rotator cuff tears

Karjalainen

Jain

Heikkinen

et al. 2019

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty

Abstract: The results of this study demonstrate no difference in clinical outcomes after rotator cuff repair with or without acromioplasty at 2 years postoperatively.

Cited by 108 publications

References 22 publications

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

Partial and Full-Thickness RCT: Modern Repair Techniques

Surgery for rotator cuff tears

Contact Info

Product

Resources

About