Arthroscopic rotator cuff repair: The learning curve

Guttmann, Dan; Graham, R.; MacLennan, Megan J.; Lubowitz, James H.

doi:10.1016/j.arthro.2004.12.006

Cited by 74 publications

(31 citation statements)

References 30 publications

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“…Nevertheless, the response rate is in-line with other postal studies for health professionals [14]. Furthermore, the results were consistent with other studies on learning arthroscopic shoulder repair which suggest that proficiency could be gained within 50 cases [15], [16]. This consistency provides some reassurance regarding external validity.…”

Section: Discussionsupporting

confidence: 88%

A Questionnaire Elicitation of Surgeons’ Belief about Learning within a Surgical Trial

et al. 2012

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IntroductionSurgeons gain expertise as they repeatedly conduct a procedure. Such learning is widely acknowledged to pose a challenge to evaluating new surgical procedures. Most surgical trials report little if any information on learning. We elicited surgeons’ belief regarding learning within the context of a randomised trial which assessed two surgical procedures.Materials and MethodsSurgeons participating in the UKUFF trial were sent a postal questionnaire requesting details on current practice, prior experience and their belief regarding acquiring proficiency and the learning curve of operation time for two surgical procedures (open and arthroscopic rotator cuff repair).ResultsIn total 52 (58%) participating surgeons returned a completed questionnaire. The median (IQR) number of procedures required to acquire proficiency were 17 (10,23) and 35 (23,50) for the open and arthroscopic repairs respectively. The distribution of surgeons’ belief regarding the initial point had median (IQR) of 109 (69,128) and 145 (97,171) minutes for open and arthroscopic repair respectively. Corresponding values for the plateau point were 60 (46, 82) and 79 (58, 110).ConclusionsWe have shown that information on the current practice, prior experience and beliefs on the learning process of a surgical procedure can be elicited using a short questionnaire. The approach could aid the interpretation of trial results in terms of generalisability and be used a priori in the design of a trial.

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Section: Discussionsupporting

confidence: 88%

A Questionnaire Elicitation of Surgeons’ Belief about Learning within a Surgical Trial

et al. 2012

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“…Studies on virtual reality simulators as well as operating-room records have shown that operative time is associated with surgical experience 3,21 . However, we chose not to use time as an end point because faster surgery may represent learning but does not necessarily predict better surgery or improved clinical outcomes 3,22 .…”

Section: Discussionmentioning

confidence: 99%

The Development of an Objective Model to Assess Arthroscopic Performance

Insel

Carofino

Leger

et al. 2009

The Journal of Bone and Joint Surgery-American Volume

103

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“…6,12 Fortunately, the proficiency of the surgeon has been shown to improve quickly, as noted by one study that reported the arthroscopic surgical time to be significantly longer (96.5 minutes) in the surgeon’s first 10 arthroscopic procedures than in the second 10 (48.4 minutes). 7 Given the numerous advantages and disadvantages of open versus arthroscopic repair, it is easy to appreciate the dilemma faced by general orthopaedists weighing whether to abandon their familiar open techniques and learn a more time-consuming and difficult arthroscopic procedure. However, given the significantly higher rate of infections with open repairs presented in this study, treating surgeons may elect for an all-arthroscopic approach.…”

Section: Discussionmentioning

confidence: 99%

“…5 Along with similar studies in the literature, these findings indicate a transition from open to arthroscopic rotator cuff repair. 4,5,7,11,12,16 …”

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confidence: 99%

Infection Rates in Arthroscopic Versus Open Rotator Cuff Repair

Hughes

Bartley

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The prevalence of rotator cuff repair continues to rise, with a noted transition from open to arthroscopic techniques in recent years. One reported advantage of arthroscopic repair is a lower infection rate. However, to date, the infection rates of these 2 techniques have not been directly compared with large samples at a single institution with fully integrated medical records.Purpose:To retrospectively compare postoperative infection rates between arthroscopic and open rotator cuff repair.Study Design:Cohort study; Level of evidence, 3.Methods:From January 2003 until May 2011, a total of 1556 patients underwent rotator cuff repair at a single institution. These patients were divided into an arthroscopic repair group and an open group. A Pearson chi-square test and Fisher exact test were used, with a subgroup analysis to segment the open repair group into mini-open and open procedures. The odds ratio and 95% CI of developing a postoperative infection was calculated for the 2 groups. A multiple-regressions model was then utilized to identify predictors of the presence of infection. Infection was defined as only those treated with surgical intervention, thus excluding superficial infections treated with antibiotics alone.Results:A total of 903 patients had an arthroscopic repair, while 653 had open repairs (600 mini-open, 53 open). There were 4 confirmed infections in the arthroscopic group and 16 in the open group (15 mini-open, 1 open), resulting in postoperative infection rates of 0.44% and 2.45%, respectively. Subgroup analysis of the mini-open and open groups demonstrated a postoperative infection rate of 2.50% and 1.89%, respectively. The open group had an odds ratio of 5.645 (95% CI, 1.9-17.0) to develop a postoperative infection compared with the arthroscopic group.Conclusion:Patients undergoing open rotator cuff repair had a significantly higher rate of postoperative infection compared with those undergoing arthroscopic rotator cuff repair.

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Arthroscopic rotator cuff repair: The learning curve

Cited by 74 publications

References 30 publications

A Questionnaire Elicitation of Surgeons’ Belief about Learning within a Surgical Trial

A Questionnaire Elicitation of Surgeons’ Belief about Learning within a Surgical Trial

The Development of an Objective Model to Assess Arthroscopic Performance

Infection Rates in Arthroscopic Versus Open Rotator Cuff Repair

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