Abstract
Background
The last decade has seen a large increase in rotator cuff surgery and arthroscopic surgery. We were asked to define the relevance of open rotator cuff repair in 2021.
Purpose
To define whether there are proven advantages to arthroscopic or open rotator cuff repair surgery.
Method
We reviewed the recent literature regarding recent trends, anaesthetic time, rehabilitation, post-operative pain, complications, economic considerations, the learning curve and outcomes. We outlined the senior authors’ technique preferences, rationale and patient reported outcomes.
Results
There is no clear evidence of proven advantage in arthroscopic rotator cuff repair compared to open rotator cuff repairs, with regard to outcomes or the other aspects reviewed. There were no differences in the outcomes of arthroscopic and open repairs in the senior authors practice with his procedure indications.
Conclusions
Open rotator cuff repair surgery remains a valid option and has some appeal in specific indications and in settings where arthroscopic resources are limited. We believe surgeons should learn both techniques and the principles of good patient selection, tissue handling, and fixation techniques are of paramount importance in both arthroscopic and open rotator cuff surgery.
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(Reproduced with permission from The Orthopaedic Journal of Sports Medicine, 2017 [1])
(Reproduced with permission from Clinical Orthopaedics and Related Research, 2019 [4])
(Reproduced with permission from The PLOS One Journal, 2012 [23])
(Reproduced with permission from The Bone and Joint Journal, 2017 [9])
(Reproduced with permission from The ANZ Journal of Surgery, 2018 [5])
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References
Jensen, A. R., Cha, P. S., Devana, S. K., et al. (2017). Evaluation of the trends, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in the medicare population. The Orthopaedic Journal of Sports Medicine., 5(10), 2325967117731310. https://doi.org/10.1177/2325967117731310 (Published 2017 Oct 12).
Day, M. A., Westermann, R. W., Bedard, N. A., Glass, N. A., & Wolf, B. R. (2019). Trends associated with open versus arthroscopic rotator cuff repair. HSS Journal, 15(2), 133–136. https://doi.org/10.1007/s11420-018-9628-2.
Iyengar, J. J., Samagh, S. P., Schairer, W., Singh, G., Valone, F. H., 3rd., & Feeley, B. T. (2014). Current trends in rotator cuff repair: Surgical technique, setting, and cost. Arthroscopy, 30(3), 284–288. https://doi.org/10.1016/j.arthro.2013.11.018.
Austin, D. C., Torchia, M. T., Lurie, J. D., Jevsevar, D. S., & Bell, J. E. (2019). Mapping the diffusion of technology in orthopaedic surgery: Understanding the spread of arthroscopic rotator cuff repair in the United States. Clinical Orthopaedics and Related Research, 477(11), 2399–2410. https://doi.org/10.1097/CORR.0000000000000860.
Bond, E. C., Hunt, L., Brick, M. J., et al. (2018). Arthroscopic, open and mini-open approach for rotator cuff repair: No difference in pain or function at 24 months. ANZ Journal of Surgery, 88(1–2), 50–55. https://doi.org/10.1111/ans.14176.
Day, M., Westermann, R., Duchman, K., et al. (2018). Comparison of short-term complications after rotator cuff repair: Open versus arthroscopic. Arthroscopy, 34(4), 1130–1136. https://doi.org/10.1016/j.arthro.2017.10.027.
Carr, A. J., Cooper, C. D., Campbell, M. K., et al. (2015). Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]. Health Technology Assessment, 19(80), 1–218. https://doi.org/10.3310/hta19800.
Pham, T. T., Bayle Iniguez, X., Mansat, P., Maubisson, L., & Bonnevialle, N. (2016). Postoperative pain after arthroscopic versus open rotator cuff repair. A prospective study. Orthopaedics & Traumatology: Surgery & Research, 102(1), 13–17. https://doi.org/10.1016/j.otsr.2015.11.005.
Carr, A., Cooper, C., Campbell, M. K., et al. (2017). Effectiveness of open and arthroscopic rotator cuff repair (UKUFF): A randomised controlled trial. The Bone & Joint Journal, 99-B(1), 107–115. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0424.R1.
Williams, G., Jr., Kraeutler, M. J., Zmistowski, B., & Fenlin, J. M., Jr. (2014). No difference in postoperative pain after arthroscopic versus open rotator cuff repair. Clinical Orthopaedics and Related Research, 472(9), 2759–2765. https://doi.org/10.1007/s11999-014-3715-6.
Kasten, P., Keil, C., Grieser, T., Raiss, P., Streich, N., & Loew, M. (2011). Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon. International Orthopaedics, 35(11), 1663–1670. https://doi.org/10.1007/s00264-011-1262-2.
Owens, B. D., Williams, A. E., & Wolf, J. M. (2015). Risk factors for surgical complications in rotator cuff repair in a veteran population. Journal of Shoulder and Elbow Surgery, 24(11), 1707–1712. https://doi.org/10.1016/j.jse.2015.04.020.
Nolan, M. B., Martin, D. P., Thompson, R., Schroeder, D. R., Hanson, A. C., & Warner, D. O. (2017). Association between smoking status, preoperative exhaled carbon monoxide levels, and postoperative surgical site infection in patients undergoing elective surgery [published correction appears in JAMA Surg. 2017 May 1;152(5):508]. JAMA Surgery, 152(5), 476–483. https://doi.org/10.1001/jamasurg.2016.5704.
Thelwall, S., Harrington, P., Sheridan, E., & Lamagni, T. (2015). Impact of obesity on the risk of wound infection following surgery: Results from a nationwide prospective multicentre cohort study in England. Clinical Microbiology & Infection, 21(11), 1008.e1–1008.e10088. https://doi.org/10.1016/j.cmi.2015.07.003.
Bayle, X., Pham, T. T., Faruch, M., Gobet, A., Mansat, P., & Bonnevialle, N. (2017). No difference in outcome for open versus arthroscopic rotator cuff repair: A prospective comparative trial. Archives of Orthopaedic and Trauma Surgery, 137(12), 1707–1712. https://doi.org/10.1007/s00402-017-2796-6.
Cho, N. S., Cha, S. W., & Rhee, Y. G. (2015). Alterations of the deltoid muscle after open versus arthroscopic rotator cuff repair. American Journal of Sports Medicine, 43(12), 2927–2934. https://doi.org/10.1177/0363546515603063.
de Castro Veado, M. A., Castilho, R. S., Maia, P. E., & Rodrigues, A. U. (2015). Prospective and comparative study on functional outcomes after open and arthroscopic repair of rotator cuff tears. Revista Brasileira de Ortopedia, 46(5), 546–552. https://doi.org/10.1016/S2255-4971(15)30410-9 (Published 2015 Dec 6).
Busfield, B. T., & Romero, D. M. (2009). Pain pump use after shoulder arthroscopy as a cause of glenohumeral chondrolysis. Arthroscopy, 25(6), 647–652. https://doi.org/10.1016/j.arthro.2009.01.019.
Adla, D. N., Rowsell, M., & Pandey, R. (2010). Cost-effectiveness of open versus arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery, 19(2), 258–261. https://doi.org/10.1016/j.jse.2009.05.004.
Churchill, R. S., & Ghorai, J. K. (2010). Total cost and operating room time comparison of rotator cuff repair techniques at low, intermediate, and high volume centers: mini-open versus all-arthroscopic. Journal of Shoulder and Elbow Surgery, 19(5), 716–721. https://doi.org/10.1016/j.jse.2009.10.011.
Wright, T. P. (1936). Factors affecting the cost of airplanes. Journal of Aeronautical Science, 3, 122–128.
Hopper, A. N., Jamison, M. H., & Lewis, W. G. (2007). Learning curves in surgical practice. Postgraduate Medical Journal, 83(986), 777–779. https://doi.org/10.1136/pgmj.2007.057190.
Cook, J. A., Ramsay, C. R., Carr, A. J., Rees, J. L., & UKUFF Trial Group. (2012). A questionnaire elicitation of surgeons’ belief about learning within a surgical trial. PLoS ONE, 7(11), e49178. https://doi.org/10.1371/journal.pone.0049178.
Gil, J. A., & Owens, B. D. (2018). Editorial Commentary: Don’t throw away the retractors: Complications of open versus arthroscopic rotator cuff repair could be influenced by indications. Arthroscopy, 34(4), 1137–1138. https://doi.org/10.1016/j.arthro.2017.11.026.
Neviaser, A. S., Charen, D. A., Cotter, J. M., Harrison, A. K., Cagle, P. J., & Flatow, E. L. (2020). Retrospective review of open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement: A single surgeon’s experience. Journal of Shoulder and Elbow Surgery, 29(5), 893–897.
Murphy, J., Gray, A., Cooper, C., Cooper, D., Ramsay, C., & Carr, A. (2016). Costs, quality of life and cost-effectiveness of arthroscopic and open repair for rotator cuff tears: An economic evaluation alongside the UKUFF trial. The Bone & Joint Journal, 98(12), 1648–1655. https://doi.org/10.1302/0301-620X.98B12.BJJ-2016-0121.R1.
Lucena, T. R., Lam, P. H., Millar, N. L., & Murrell, G. A. (2015). The temporal outcomes of open versus arthroscopic knotted and knotless rotator cuff repair over 5 years. Shoulder & Elbow, 7(4), 244–255. https://doi.org/10.1177/1758573215581775.
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Mohammed, K.D., Lloyd, R.F.W., Nagaraj, C. et al. The Relevance of Open Rotator Cuff Repair in 2021. JOIO 55, 433–442 (2021). https://doi.org/10.1007/s43465-020-00345-7
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DOI: https://doi.org/10.1007/s43465-020-00345-7