Shoulder
Arthroscopic repair of large rotator cuff tears using the double-row technique: an analysis of surgeon experience on efficiency and outcomes

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Background

Arthroscopic rotator cuff repair is one of the most commonly performed procedures in the orthopaedic specialty. The goal of this study was to evaluate the effect(s) of surgical experience on efficiency and patient outcomes after double-row rotator cuff repair.

Methods

A retrospective review of 69 consecutive patients with large rotator cuff tears who underwent double-row arthroscopic rotator cuff repair by 1 surgeon from the start of practice was conducted. We divided the patients into 2 cohorts: group 1, early (first 18 months of study period) (n = 35), and group 2, recent (final 12 months of study period) (n = 34). Outcome measures including American Shoulder and Elbow Surgeons score, Penn Shoulder Score, and range of motion were assessed preoperatively and at final follow-up. In addition, we compared the operative times between the groups.

Results

At a mean follow-up of 13.25 months, both cohorts showed significant improvement (P < .001) in American Shoulder and Elbow Surgeons scores (from 47.9 to 76.5 and from 43.6 to 79.4 in groups 1 and 2, respectively) and Penn Shoulder Scores (from 45.8 to 80 and from 38.7 to 79.6 in groups 1 and 2, respectively) postoperatively. The magnitude of change and final scores were similar between the groups. Similar improvements in range of motion were noted in both groups. Patients in group 1 had a statistically significantly longer mean operative time than those in group 2 (116 minutes vs 99.7 minutes, P = .036).

Conclusion

Double-row rotator cuff repair provides predictable improvement in pain and function. It can be performed effectively early in a surgeon's career. However, with experience, efficiency is improved.

Section snippets

Methods

We performed a retrospective review of the rotator cuff repairs performed by a single shoulder and elbow fellowship–trained surgeon, starting with his first repair. These data spanned 30 months, from November 1, 2005 to May 1, 2008.

Inclusion criteria included (1) age of 18 years or older; (2) full-thickness, large tears (3-5 cm)4; and (3) complete medical record including preoperative and postoperative data. Exclusion criteria included patients with (1) less than 6 months’ follow-up, (2)

Results

This study included 69 patients, 35 in the early group and 34 in the late group. The mean ages of patients were similar between the groups: 63 years and 65 years in groups 1 and 2, respectively. Patients in groups 1 and 2 were followed up for a mean of 12.9 months (range, 6-34 months; SD, 8.5 months) and 13.6 months (range, 6-28 months; SD, 5.5 months), respectively. Both groups were noted to be similar in terms of demographics (Table I).

Discussion

Rotator cuff repair has become one of the most commonly performed orthopaedic surgical procedures with relatively consistent good clinical results reported.18, 21, 22 The techniques used to approach rotator cuff surgery have evolved over the years from open to arthroscopic. Correspondingly, recent reports have failed to show significant advantages of the open and mini-open approaches compared with the arthroscopic approach in terms of clinical and functional outcomes.12, 20, 24, 25

Despite

Conclusion

This study provides insight as to the effects of surgical experience on outcomes. In 2 patient cohorts, we noted that satisfactory results after rotator cuff repair are attainable early in one's practice albeit with possibly longer operative times. Further research is required to better elucidate training-specific factors that better prepare surgeons entering practice.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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  • Cited by (0)

    Study approved by the University of Pennsylvania Institutional Board Review (No. 811418).

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