Delayed rotator cuff repair may increase risk of revision
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Patients who underwent delayed rotator cuff repair beyond 12 months of diagnosis had an increased risk of undergoing subsequent revision rotator cuff repair, according to results.
Michael C. Fu, MD, MHS, of Hospital for Special Surgery, and colleagues stratified 2,759 patients who underwent arthroscopic rotator cuff repair into an early (fewer than 6 weeks; 57.4%), routine (between 6 weeks and 12 months; 40%) or delayed (more than 12 months; 5.3%) repair cohorts. Researchers compared the rates of subsequent revision rotator cuff repair among the cohorts.
Results showed an overall revision rate of 9.6% at 5-year follow-up. Researchers found patients in the delayed group had a revision rate of 15.2% compared with 9.9% and 8.3% in the early and routine groups, respectively. Patients who underwent delayed repair had increased odds of revision surgery vs. routine repair, according to multivariate analysis. Researchers noted no association between risk of revision surgery with patient sex and Charlson Comorbidity Index, while patients older than 75 years of age had decreased odds of revision compared with patients younger than 75 years of age.
“For patients with symptomatic rotator cuff tears that have not responded to non-surgical treatment, rotator cuff repair within 12 months of diagnosis is associated with a decreased risk of needing subsequent revision surgery,” Fu told Healio Orthopedics. “These results will hopefully inspire continuing research into the biologic explanations for this finding and ways to improve our outcomes following rotator cuff repair.”
Perspective
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Nickolas Garbis, MD
Routinely, one of the most difficult questions we have to answer in the office is, “Doc, how long can I wait to have my surgery?” Rotator cuff repair is a common procedure that can relieve pain and potentially increase function, but the patient’s time commitment can be onerous.
The analysis was well performed and designed appropriately. As with many database studies there are some limitations, which the authors readily identify. These include relying on date of diagnosis not date of injury, potential sampling and selection bias, and insurance coverage crossover. Despite these, the data extracted could be valuable for counseling patients during shared decision-making discussions.
The three groups were: early (less than 6 weeks), routine (6 weeks to 12 months) and delayed (more than 12 months). The odds ratio for revision surgery in the delayed repair group was calculated at 1.97. Revision rate for the delayed repair group was 15.2% compared to 9.9% in the early and 8.3% in the routine groups.
When discussing operative timing with patients, we can educate them about the natural history of rotator cuff disease, but it is also nice to be able to say the data suggest waiting over a year can put them at higher risk of revision repair. Congratulations on a nice and clinically applicable manuscript.
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