The Societal and Economic Value of Rotator Cuff Repair

Mather, Richard C.; Koenig, Lane; Acevedo, Daniel Camilo Aguirre; Dall, Timothy M.; Gallo, Paul; Romeo, Anthony A.; Tongue, John R.; Williams, Gerald R.

doi:10.2106/jbjs.l.01495

Cited by 340 publications

(241 citation statements)

References 25 publications

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“…Rotator cuff tears are a common cause of pain and disability [1,2] . In patients meeting indications for surgery, rotator cuff repair has been shown to have good long-term clinical results [3,4] .…”

Section: Introductionmentioning

confidence: 99%

Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

162

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Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair. Core tip: Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscletendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing after rotator cuff repair. Smoking cessation and blood glucose and cholesterol control are methods to potentially improve healing rates. Slower, less aggressive rehabilitation programs may improve healing rates with no negative effect on final range of motion and are therefore recommended after arthroscopic repair of most full thickness tears. Finally, no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates after rotator cuff repair. Routine use of these adjuvants is therefore not currently recommended.

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Section: Introductionmentioning

confidence: 99%

Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

162

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“…Lastly, as a group, orthopedic surgeons will be wise to justify reimbursement by proving the value of their work. The AAOS is already leading this effort by demonstrating the cost-effectiveness of several common orthopedic interventions [80][81][82][83].…”

Section: Discussionmentioning

confidence: 99%

Medicare reimbursement and orthopedic surgery: past, present, and future

Clement

Bhat

Clement

et al. 2017

Curr Rev Musculoskelet Med

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“…The expense of repairing and rehabilitating a RCT should be seen in the content of the social and financial burden of untreated symptomatic disease. 108 The efficacy of treatment is currently being examined by the UKUFF trial run by Professor Andy Carr from Oxford and involves approximately one-third of the specialist shoulder surgeons in the UK through the British Elbow and Shoulder Society. The trial aims to distinguish between rehabilitation alone, arthroscopic repair and open surgical repair in the management of well defined RCTs.…”

Section: Treatment Specified By Patho-biomechanicsmentioning

confidence: 99%

Assessment and treatment strategies for rotator cuff tears

2014

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Tears of the rotator cuff are common and becoming an increasingly frequent problem. There is a vast amount of literature on the merits and limitations of the various methods of clinical and radiological assessment of rotator cuff tears. This is also the case with regard to treatment strategies. Certain popular beliefs and principles practiced widely and the basis upon which they are derived may be prone to inaccuracy. We provide an overview of the historical management of rotator cuff tears, as well as an explanation for how and why rotator cuff tears should be managed, and propose a structured methodology for their assessment and treatment.

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The Societal and Economic Value of Rotator Cuff Repair

Cited by 340 publications

References 25 publications

Factors affecting healing after arthroscopic rotator cuff repair

Factors affecting healing after arthroscopic rotator cuff repair

Medicare reimbursement and orthopedic surgery: past, present, and future

Assessment and treatment strategies for rotator cuff tears

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