2019 ISAKOS Biennial Congress ePoster #2028
Delay to Arthroscopic Rotator Cuff Repair Increases Revision Surgery Rates
Evan A. O'Donnell, MD, New York, NY UNITED STATES
Michael C. Fu, MD, MS, New York, NY UNITED STATES
William Schairer, MD, New York, NY UNITED STATES
Samuel A. Taylor, MD, New York, NY UNITED STATES
Joshua S. Dines, MD, Uniondale, NY UNITED STATES
David M. Dines, MD, Uniondale, NY UNITED STATES
Russell F. Warren, MD, New York, NY UNITED STATES
Lawrence V. Gulotta, MD, Chappaqua, NY UNITED STATES
The Hospital for Special Surgery, New York, NY, UNITED STATES
FDA Status Not Applicable
Delaying rotator cuff repair over one year from the diagnosis of a rotator cuff tear was associated with significantly higher revision surgery rates.
The timing for the surgical treatment of rotator cuff (RC) tears continues to be controversial. While re-tear and revision rotator cuff repair (RCR) rates have been previously described, there remains a paucity of literature on the effect of the timing from diagnosis of a RC tear to primary RCR, and the subsequent revision RCR rates.
A national insurance database was searched from 2007 to 2016 for all patients with 5-year follow-up after the diagnosis of a RC tear, who also underwent primary arthroscopic RCR. International Classification of Diseases Ninth Revision (ICD-9) diagnostic codes and Current Procedural Terminology (CPT) codes for used to identify RC tears and arthroscopic RCRs, respectively. Laterality modifiers for the primary surgery were used to identify subsequent revision arthroscopic RCRs. The time interval between diagnosis and arthroscopic RCR was tracked, and patients were parsed into 3 groups: Acute repair (0 to 6 weeks from RC tear diagnosis), routine repair (6 weeks to 1 year), and delayed repair (1 to 2 years after RC tear diagnosis). Age, gender, and Charlson Comorbidity Index (CCI) were recorded as patient characteristics. The data were analyzed with chi-squared testing and multivariable logistic regression.
Included in the study were 2,759 patients with 5-year follow up from the diagnosis of a RC tear, who subsequently underwent arthroscopic RCR. Acute and routine arthroscopic RCR were most common, representing 54.7% and 40.0% of all RCRs, respectively. The average time from RC tear diagnosis to primary RCR was 86.0 days. The overall revision rate was 9.6%, which occurred on average 89.1 days after the primary surgery. Patients who underwent routine arthroscopic RCR had a significantly lower rate of revision surgery when compared to delayed repair (8.3% vs. 15.2%). In multivariable logistic regression, delayed RCRs predicted increased rates of revision surgery (OR 1.97).
Most arthroscopic RCRs were performed promptly after the diagnosis of a RC tear, with the average time to surgery found to be approximately 3 months. More than 5% of arthroscopic RCRs were performed 1 year after the diagnosis of a RC tear. The revision rate of the delayed RCR cohort was significantly higher than the rate of those patients who underwent routine RCR. Further, delayed RCR was found to be an independent predictor for revision arthroscopic RCR when controlling for age and comorbidity burden. These findings suggest a benefit to performing arthroscopic RCR within 1 year of the diagnosis of a RC tear.