THE NUMBER OF SURGEONS USING SUPERIOR CAPSULAR RECONSTRUCTION FOR ROTATOR CUFF REPAIR IS DECLINING
Figure 1 - Surgeons were queried on what percentage of their cases where the rotator cuff tear was considered "irreparable" that they performed SCR. A total of 4% of surgeons who reported using the SCR technique used SCR in greater than 90% of their irreparable RCR cases, as compared with 38% reporting they used SCR in less than 10% of their irreparable cases. (RCR, rotator cuff repair; SCR, superior capsular reconstruction.)
Purpose: To investigate surgeon preferences for graft use, including biologic augmentation and superior capsular reconstruction (SCR) associated with surgical treatment of rotator cuff repair (RCR).
Methods: A 26-question survey was completed by arthroscopic shoulder surgeons. Surgeon demographics were evaluated. Surgeons were queried about shoulder arthroscopic graft use and rationale then responses were analyzed based on demographics.
Figure 2 - The survey aimed to evaluate a 5-year period of SCR use. It was found that, overall, the majority of surgeons (38%) responded they never or almost never use SCR. The exception was surgeons performing greater than 100 RCR/year and those employed in the hospital setting reportedly increased use of SCR at 42% and 44%, respectively. (RCR, rotator cuff repair; SCR, superior capsular reconstruction.)
Results: In total, 260 surgeons completed the survey. Fifty-one percent of surgeons reported a decrease in the volume of SCR use in the past 5 years. Less than 3% of surgeons used SCR in >90% of irreparable RCR cases, compared with 38% using SCR in <10% of irreparable cases (P < .05). Surgeons performing >100 RCR annually (42%; P < .05) and those employed in the hospital setting (44%; P < .05) reported an overall increase in the use of SCR. More international surgeons (67%) decreased their use of SCR compared with U.S. surgeons (44%; P < .05). In contrast, bioinductive graft use is generally on the rise, with 48% of surgeons reporting increased use since first use, although used in <10% of cases by 54% of surgeons. Sixty-eight percent of surgeons performing >100 RCRs annually used bioinductive grafts (P < .05). Fewer international surgeons (30%) performed biologic augmentation (P < .05). Suboptimal published outcomes (40%) and no perceived patient benefit (40%) were most cited for decreased SCR use. Surgeons reporting increased use cited improved personal patient outcomes (72%).
Figure 3 - Surgeons who reported use of biologics grafts were queried on what percentage of their RCRs they used biologic matrices. A total of 1.48% of surgeons used biologics in greater than 90% of their cases, while 54% used in fewer than 10% of cases. (RC, rotator cuff; RCR, rotator cuff repair.)
Figure 4 - Surgeons reporting use of bridging grafts were asked what perfect of RCR cases that are not fully repairable would they use biologic grafting. In total, 6% of surgeons would use in greater than 90% of cases, whereas 55% would use in fewer than 10% of cases. (RCR, rotator cuff repair.)
Conclusions: Arthroscopic surgeons report decrease in volume of SCR use in the past 5 years. Surgeon's personal experience of patient outcome and suboptimal published results were the strongest factors impacting decision-making. In contrast, bioinductive graft use is increasing. However, most surgeons use these grafts in a relatively small percentage of cases.
Clinical relevance: Evaluation of scientific data, personal experience, and influences on surgical practice will give a comprehensive understanding of current RCR practices.
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Published November 17, 2022 in Arthroscopy, Sports Medicine, and Rehabilitation (Volume 4 - Issue 6).