Gaston Davis B.S. , Usman Zareef B.A. , Andres Perez B.A. , Ryan W. Paul B.S. , Daniel Givner B.S. , Brandon J. Erickson M.D. , Kevin B. Freedman M.D. , Steven B. Cohen M.D. , Fotios P. Tjoumakaris M.D.
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Abstract
Purpose
To compare revision rates and functional outcomes between patients who underwent staged versus simultaneous bilateral rotator cuff repair (RCR).
Methods
This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with no institutional review board approval or funding required. The PubMed, SportDiscus, and Ovid Medline databases were queried to identify original research studies evaluating preoperative characteristics and postoperative outcomes of staged or simultaneous RCR. The following search algorithm was used: ((Bilateral) OR (simultaneous) OR (Staged)) AND (rotator cuff repair). Demographics including the number of male and female patients, age, type of surgical intervention, time between staged surgery, and surgical indication were collected. Variables of interest included pre- and postoperative shoulder pain and functional scores, as well as retear, reoperation, revision, complications, and their rates of occurrence.
Results
Overall, 594 studies were screened, and 8 studies were included in this systematic review. In total, 11,188 patients (97.5%) underwent staged repair and 286 (2.5%) underwent simultaneous repair. Delaying staged surgery by more than 2 years also had decreased surgical complications such as conversion to reverse total shoulder arthroplasty, postoperative infection, venous thromboembolism, and emergency department visits when compared with simultaneous RCR (P ≤ .031) and earlier staging (less than 3 months) (P ≤ .015). In addition, one study found staged RCR had better patient-reported outcome measures (University of California-Los Angeles, Constant, and American Shoulder and Elbow Surgeons scores; P < .001) when staged greater than 9 months apart.
Conclusions
Staged RCR has superior functional outcomes, decreased surgical complications, as well as lower revision rates than simultaneous RCR.
Level of Evidence
Level IV, systematic review of Level II-IV studies.
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