Summary

ABOS Step II examinees that completed a Sports Medicine fellowship reported the lowest complication rates, however not statistically less than Shoulder and Elbow or Hand and Upper Extremity fellowships

Abstract

Background

Rotator cuff repair (RCR) is one of the most frequently performed elective orthopaedic procedures. Original surgical techniques for RCR consisted of open/mini-open approaches with later development of arthroscopic approaches.

Purpose

The two purposes of this study were to evaluate the practice pattern and assess the complication rate among fellowship trained Step II examinees of the American Board of Orthopedic Surgery (ABOS) for RCR from 2007-2017).

Methods

The ABOS database was queried for both arthroscopic (ICD code 29827) and open/mini-open (ICD codes: 23410, 23412) RCR performed from 2007-2017. A comparison between arthroscopic and open/mini-open utilization, overall complication rate as well as reported complications were assessed based upon recorded fellowship training. Study Design: Retrospective cohort study. Level of Evidence: Level III.

Results

A total of 31,907 RCR were reported over the past 10 years (2007-2017). Percentage of RCR procedures performed using arthroscopic technique vs open/mini-open varied among surgeons who completed one fellowship: Sports Medicine (92.5 % arthroscopy; 7.5 % mini/open), Shoulder & Elbow (91.3 % arthroscopy; 8.7% mini/open), Hand & Upper Extremity (69.6 % arthroscopy; 30.4 % open). Total complication rates varied among surgeons who completed one fellowship: Sports Medicine (11.5 %), Shoulder & Elbow (13.5 %), Hand & Upper Extremity (13.4 %). Surgeons completing one fellowship in either Sports Medicine, Shoulder & Elbow, Hand & Upper Extremity all had significantly lower complication rates in arthroscopy vs open technique (p < 0.001). Surgeons who completed 3 or more fellowships had a high total complication rate (20.2 %) as well as no statistically significant difference in complication rates between arthroscopic and open (p = 0.4).

Conclusion

ABOS Step II examinees that completed a Sports Medicine fellowship reported the lowest complication rates, however not statistically less than Shoulder and Elbow or Hand and Upper Extremity fellowships. All 3 fellowships reported a statistically lower complication rate using arthroscopy compared to open/mini-open RCR over the past 10 years. Interestingly, surgeons that completed 3 or more fellowships had a significantly higher complication rate regardless of surgical technique. These results highlight a pattern favoring the use of arthroscopic RCR as well as a lower reported complication rate when compared to open/mini-open RCR.