Summary

In a large cohort of over 60,000 patients with partial or complete rotator cuff tears, performing concurrent SAD conferred a 26% relative risk reduction (NNT»4 patients) for revision rotator cuff repair when compared to ARCR alone.

Abstract

Purpose

Subacromial decompression (SAD) during arthroscopic rotator cuff repair (ARCR) has traditionally been performed to relieve impingement of the rotator cuff tendons as they pass through the subacromial space. The purpose of this study is to quantify the reduced risk of revision rotator cuff surgery conferred by performing SAD with ARCR.

Methods

The PearlDiver administrative claims database was queried for patients who underwent ARCR between 2015-2020 with a minimum follow up of 2 years. The study population was stratified by whether concurrent SAD was performed at the time of the index ARCR. Groups were matched on age, gender, Charlson Comorbidity Index (CCI), complete versus partial tear, and comorbidities previously correlated with RCR healing. The primary outcome was requiring a revision rotator cuff repair.

Results

The final analysis included 30,407 patients per group, with a mean age of 60 years (SD=7) and 45.3% women. Baseline demographics were similar between groups after matching. 551 (1.8%) patients without SAD vs. 437 patients with SAD (1.4%) underwent a revision rotator cuff repair, corresponding to a number needed to treat (NNT) of 3.8 (unadj-OR=0.79. 95% CI 0.70-0.90, P<0.001). In a multivariable model, factors associated with revision rotator cuff repair included subacromial decompression (adj-OR=0.79, 95%CI 0.70-0.90, P<0.001), male gender (adj-OR 0.97, 95% CI 0.97-0.98, P=0.017), older age (adj-OR=0.97, 95% CI 0.97-0.98, P<0.001), complete tear (adj-OR=3.62, 95% CI 2.87-4.57, P<0.001), tobacco use (adj-OR 1.33, 95% CI 1.12-1.52, P<0.001), and CCI (adj-OR 1.05, 95% CI 1.01-1.09, P=0.027).

Conclusions

In a large cohort of over 60,000 patients with partial or complete rotator cuff tears, performing concurrent SAD conferred a 26% relative risk reduction (NNT»4 patients) for revision rotator cuff repair when compared to ARCR alone. These findings suggest that SAD may reduce the risk of revision rotator cuff surgery.