What’s New in Shoulder and Elbow Surgery

Abstract

Specific emphasis has been placed on higher-quality research (Level-I and II studies) and particularly relevant Level-III studies. Rotator Cuff RepairThe decision to indicate operative repair for degenerative rotator cuff tears is controversial. Kukkonen et al. 1 provided a mean 6.2-year follow-up in 150 patients who were >55 years of age; had small, full-thickness supraspinatus tears; and were randomized to physiotherapy only, acromioplasty and physiotherapy, or repair, acromioplasty, and physiotherapy. The mean change in Constant score (the primary outcome) was similar in the 3 groups, as were changes in the visual analog scale (VAS) pain and satisfaction scores. There was a significant progression of arthritis from baseline to follow-up for the entire cohort without a difference between groups. The authors suggested that operative repair is no better than conservative treatment and does not protect against degeneration of the glenohumeral joint.Long-term follow-up comparing single-row and doublerow repair techniques is uncommon. Lapner et al. 2 reported a 10-year follow-up to a previous 2-year report of a randomized controlled trial (RCT) of 90 patients comparing single-row and double-row repair. At 10 years, the Western Ontario Rotator Cuff Index (WORC) scores were higher in the double-row group. Between 2 and 10 years, significant decreases in the WORC and American Shoulder and Elbow Surgeons (ASES) scores were seen in the single-row repair group but not in the double-row repair group. Only 30 patients had 10-year ultrasound data, which demonstrated similar retear rates between groups: 23% for the single-row repair group compared with 42% for the double-row repair group (p = 0.418). The authors concluded that double-row fixation preserved joint function Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H167).