Is Acromioplasty Ever Indicated During Rotator Cuff Repair?

Jarvis, D. Landry; Waterman, Brian R.; Verma, Nikhil N.

doi:10.1016/j.arthro.2019.04.008

Cited by 9 publications

(6 citation statements)

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“…[8][9][10] The clinical benefit of these additional procedures, however, remains unclear because previous reports have identified no functional benefit or reduction of revision risk with the concomitant use of an acro in RCR. [11][12][13][14] Tenotomy or tenodesis is often favored when long head of the biceps tendon pathology is noted during surgery, with all techniques having similar clinical outcomes. [15][16][17][18][19] Lesions of the long head of the biceps tendon (LHBT) are also often associated with RCTs and may be managed nonoperatively, with a tenotomy, or a BT.…”

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confidence: 99%

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Costs, Complications, and Reoperations Associated With Primary Arthroscopic Rotator Cuff Repair With or Without Acromioplasty and/or Biceps Tenodesis

Varshneya

Safran

Sherman

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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To evaluate the reoperations, complications, and costs up to 5 years following arthroscopic rotator cuff repair (RCR) alone, with acromioplasty (acro), with biceps tenodesis (BT), or with both acro and BT. Methods: We queried the MarketScan database to identify patients who underwent RCR from 2007 to 2016. Patients were stratified into groups based on concomitant procedures (acro and/or BT) performed on the same day as index RCR. Reoperations, complications, and costs were followed for 5 years post-index procedure. Patients without laterality codes were excluded. A multivariate logistic regression analysis was used to control for confounding factors. Results: This study identified 147,838 patients (mean age, 53.1 years; standard deviation, 8.3 years) who underwent primary RCR. Patients were stratified into 4 groups: (1) RCR only, (2) RCR þ acro, (3) RCR þ BT, and (4) RCR þ acro þ BT. Patients in the RCR only group experienced the highest rate of unadjusted overall postoperative complications (17.2%) versus the other groups (RCR þ acro 16.4%, RCR þ BT 15.1%, RCR þ acro þ BT 16.2%, P < .0161). The RCR only group also experienced a significantly greater number of reoperations on the ipsilateral shoulder (P < .0001), whereas the RCR þ acro þ BT had the highest costs at all timepoints. In the regression analysis, there was no significant differences between complications and reoperations between any groups. After adjusting for covariates, the performance of a BT with an RCR and acromioplasty led to increased costs (odds ratio, 1.47, 1.37-1.59, P < .001). Conclusions: Concomitant biceps tenodesis does lead to higher total healthcare costs, both in the shorter and longer terms. When adjusting for confounding factors, the performance of concomitant biceps tenodesis with rotator cuff repair does not lead to a difference in postoperative complication rate or risk for revision surgery. Level of Evidence: Level IV, economic analysis.

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confidence: 99%

“…8 , 9 , 10 The clinical benefit of these additional procedures, however, remains unclear because previous reports have identified no functional benefit or reduction of revision risk with the concomitant use of an acro in RCR. 11 , 12 , 13 , 14 …”

mentioning

confidence: 99%

Costs, Complications, and Reoperations Associated With Primary Arthroscopic Rotator Cuff Repair With or Without Acromioplasty and/or Biceps Tenodesis

Varshneya

Safran

Sherman

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Fifth, the contribution of acromioplasty or biceps interventions to scapular kinematics was not investigated. Acromioplasty may affect scapular motion by causing subacromial adhesion and postoperative stiffness [24] or by reducing external impingement [10]. The biceps intervention may have changed the scapular kinematics by eliminating the possible role of the long head of the biceps in glenohumeral stability, humeral head depression, and overall glenohumeral kinematics [33, 35].…”

Section: Discussionmentioning

confidence: 99%

Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression

Song

Yoon

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeTo investigate the incidence of scapular dyskinesis (SD) in patients with rotator cuff tears using pre‐ and postoperative 3D computed tomography, analyze the changes in scapular kinematics that occur after arthroscopic rotator cuff repair, and identify the contributing clinical factors. MethodsThirty‐five patients (mean age, 62.5 ± 8.4 years) were included. Four scapular angles (upward rotation, internal rotation, protraction, and posterior tilt) were measured. The patients were categorized into three pre‐existing SD types according to the difference in measured scapular angles between the affected and unaffected sides (type 1 SD, posterior tilt angle difference < − 5°; type 2 SD, internal rotation angle difference > 5°; and type 3 SD, upward rotation angle difference > 5°). The prevalence, factors influencing SD, and outcomes were compared between the improved and sustained SD groups. ResultsTwenty three of the 35 patients (65.7%) with rotator cuff tears had SD (type 1, 11; type 2, six; type 3, six). Of the 23 preoperative SD patients, 12 (52.1%) showed improved SD postoperatively. Most of the patients with improved SD (9/12) had type 1 SD (p = 0.021) and a significantly improved posterior tilt angle (p = 0.043). The improvement in SD was correlated with a higher range of motion of forward flexion and higher Constant scores (all p < 0.05). No healing failure occurred in the improved SD group (p = 0.037). ConclusionThe prevalence of SD was high in patients with degenerative rotator cuff tears. More than half of the SD cases, especially type 1 SD, improved postoperatively. SD recovery correlated with better function and successful rotator cuff healing. Level of evidenceIV.

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“…Although the clinical value of subacromial decompression (bursectomy, coracoacromial ligament release, and acromioplasty) may be limited, it increases the working space within the subacromial space thereby enhancing visualisation of the tear, decreasing wear from a type III acromion, and release important growth factors to augment the healing process. 11,12 On the other hand, subacromial decompression may contribute antero-superior escape, weakening of the deltoid insertion, and does not result in a better functional outcome following tendon repair. 13e15 With this in mind, we recommend always carrying out a comprehensive bursectomy to aid visualisation whilst reserving a coraco-acromial ligament release ± acromioplasty for those cases where anterosuperior escape is not a concern (e.g.…”

Section: Reaching the Tearmentioning

confidence: 99%

Rotator cuff repair techniques: Current concepts

Thangarajah

Sabo

2021

Journal of Clinical Orthopaedics and Trauma

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Arthroscopic rotator cuff repair is being performed by an ever-increasing number of surgeons. With an ageing population and growing patient expectations it is crucial that clinical outcomes are optimised. Anatomical reduction of the tendon back to its footprint with minimal tension contributes to this, but this can only be achieved if key biomechanical factors are taken into consideration. In this review of the technical aspects of a rotator cuff repair, we focus on: (1) patient positioning, (2) biomechanical principles, (3) optimal visualisation, and (4) repair techniques for both anterior and postero-superior tears.

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Is Acromioplasty Ever Indicated During Rotator Cuff Repair?

Cited by 9 publications

References 0 publications

Costs, Complications, and Reoperations Associated With Primary Arthroscopic Rotator Cuff Repair With or Without Acromioplasty and/or Biceps Tenodesis

Costs, Complications, and Reoperations Associated With Primary Arthroscopic Rotator Cuff Repair With or Without Acromioplasty and/or Biceps Tenodesis

Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression

Rotator cuff repair techniques: Current concepts

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