Review Question - QID 219948

Rotator Cuff Tears Technique Arthroscopic rotator cuff repair QID: 219948 (SBQ24SM.54)

QID 219948 (Type "219948" in App Search)

A 52-year-old man presented to the orthopedic clinic with a nine-month history of right shoulder pain. He was previously diagnosed with an isolated full-thickness supraspinatus tear. Figures A and B show his shoulder MRI and plain films, respectively. He has completed 6 months of physical therapy and a subacromial steroid injection, but has persistent pain and weakness. The physical exam revealed a positive empty can and a Neer impingement test. The patient is accurately informed that rotator cuff repair with acromioplasty has which outcome when compared to superior rotator cuff repair without acromioplasty?

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Increased symptomatic retear rate

53/839

Increased range motion

64/839

Improved patient reported outcomes

33%

273/839

Increased strength

4/839

Lower risk of long-term reoperation

52%

438/839

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In several randomized trials, acromioplasty has shown no difference in symptomatic retear rate, range of motion, strength, or patient-reported outcomes. Level 1 evidence shows increased rates of revision surgery in rotator cuff repair without acromioplasty, especially in type 2 and 3 acromions.

Rotator cuff tears are a common source of shoulder pain and present as traumatic or degenerative tears. Degenerative tears are postulated to typically start on the bursa side of the cuff and are exacerbated by subacromial impingement. Acromioplasty is a surgical procedure that flattens the bottom of the acromion to prevent impingement of the rotator cuff between the acromion and the humerus. Although acromioplasty is frequently performed concurrently with a degenerative rotator cuff repair, recent evidence has questioned the efficacy of this practice. Acromioplasty at the time of rotator cuff repair shows no difference in range of motion, patient-reported outcome, symptomatic retear, strength, or post-operative pain.

Woodmass et al. published the long-term results of a randomized trial comparing full-thickness rotator cuff tears with or without acromioplasty. 56 of the original 86 patients were available for follow-up at a mean of 11 years. There was no difference in patient-reported outcomes. 16% of patients without the acrimoplasty underwent reoperation while 2% in the acrimoplasty group underwent reoperation. All patients who underwent reoperation in both groups had either type 2 or 3 acromion. The authors conclude that an acromioplasty should be considered in patients with an amorphous acromion.

Waterman et al. published the long-term results of 69 patients from a randomized trial completed between 2007 and 2011 that compared arthroscopic full-thickness rotator cuff repair with or without acromioplasty. At an average follow-up time of 7.5 years, there was no difference in patient-reported outcomes, retear rate, or revision cuff repair. The authors do not make a formal recommendation for or against acromioplasty.

Abrams et al. published the results from a randomized clinical trial of 114 patients comparing full-thickness rotator cuff repair with or without acromioplasty. At a minimum of 2-year follow-up, the authors found no difference in patient-reported outcomes, range of motion, or dynamometer strength testing. The authors do not make a formal recommendation for or against acromioplasty.

Figure A shows a coronal MRI slice of a full-thickness supraspinatus tear. Figure B shows an axillary lateral plain film showing a type-3 acromion.

Incorrect Answers:
Answer 1: Several randomized controlled trials have found no difference in symptomatic retear rate
Answer 2: Several randomized controlled trials have found no difference in postoperative shoulder range of motion
Answer 3: Several randomized controlled trials have found no difference in patient-reported outcomes
Answer 4: Level 1 evidence found no difference in strength testing