SUPRASPINATUS TEARS
In the absence of reliable evidence, it is the opinion of the workgroup that for patients with small isolated, repairable supraspinatus tears, clinicians can perform anatomic total shoulder arthroplasty (TSA)

Rationale

None of the studies derived from the literature search for GJO specific to repairable rotator cuff tears and anatomical total shoulder arthroplasty met the criteria for CPG inclusion. These studies were not included for multiple reasons including inadequate sample size (less than 20 patients per group), etiology for reconstruction, and lack of comparison group. However, several studies have indicated favorable results regarding anatomic total shoulder arthroplasty in the setting of a repairable rotator cuff tear. Simone et al reported the greatest improvement in forward elevation after anatomic TSA in ten patients that demonstrated a small rotator cuff tear. Complications only occurred in patients with medium and large rotator cuff tears (instability, glenoid component loosening, and periprosthetic fracture). Iannotti et al reported on thirteen shoulders that exhibited a repairable full-thickness tear of the supraspinatus tendon with anatomic TSA. These tears did not affect the overall American Shoulder and Elbow Surgeons score, pain relief or patient satisfaction. Rispoli and colleagues in their case series similarly did not find that isolated supraspinatus tendon tears affected shoulder-specific outcome parameters during shoulder arthroplasty when performed for the treatment of primary osteoarthritis. In contradistinction, Livesey et al noted a poor result in 31% of patients that underwent concomitant rotator cuff repair and anatomic TSA, underscoring the challenges that this clinical scenario presents.

 

Strength of Evidence (quality of evidence): No reliable evidence

 

Benefits & Harms:

In the setting of GJO with a rotator cuff tear, surgeons must make a critical decision to proceed with anatomical shoulder arthroplasty with rotator cuff repair versus reverse shoulder arthroplasty. The potential for revision of failed anatomic TSA due to rotator cuff insufficiency must be weighed against the risks of increased complication rates after primary reverse shoulder arthroplasty.

 

Outcome Importance:

It is important to determine the safety of anatomic shoulder arthroplasty in the setting of a repairable rotator cuff tear as a platform based anatomic arthroplasty may be readily converted to a reverse total shoulder. This option provides the practitioner and patient more options than immediately proceeding to reverse total shoulder.

 

Cost Effectiveness/Resource Utilization:

Evidence-based decisions regarding implant choice should ideally result in decreased long term costs by reducing the need for revision surgery, decreasing the utilization of higher cost reverse total shoulder arthroplasty, and improving long-term pain and return to work.

Acceptability and Feasibility:

Anatomic total shoulder replacement and open rotator cuff repair are familiar and well-accepted by orthopaedic surgeons. These implants and surgical techniques are widely available and reproducible.

 

Future Research: 

Future high-quality studies are necessary to directly compare patients with GJO with an intact rotator cuff versus those with repairable small (< 1 cm) supraspinatus tendon tears when performing anatomic total shoulder arthroplasty with respect to patient reported outcomes, complications, and revision rates.

 

Additional References:

Simone, J.P., Streubel, P.H., Sperling, J.W., Schleck, C.D., Cofield, R.H., Athwal, G.S., Anatomical total shoulder replacement with rotator cuff repair for osteoarthritis of the shoulder. Bone Joint J. 2014;96-B(2):224-8. 

Iannotti, J.P., Norris, T.R., Influence of preoperative factors on outcome of shoulder arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am. 2003;85(2):251-8.

Livesey, M., Horneff, J.G., Shoulder, D., Lazarus, M., Williams, G., Namdari, S., Functional Outcomes and Predictors of Failure After Rotator Cuff Repair During Total Shoulder Arthroplasty. Orthopedics. 2018;41(3):e334-e339.

Edwards, T.B., Boulahia, A., Kempf, J.F., Boileau, P., Nemoz, C., Walch, G., The influence of rotator cuff disease on the results of shoulder arthroplasty for primary osteoarthritis: results of a multicenter study. J Bone Joint Surg Am. 2002;84(12):2240-8.

Rispoli, D.M., Sperling, J.W., Athwal, G.S., Schleck, C.D., Cofield, R.H., Humeral head replacement for the treatment of osteoarthritis. J Bone Joint Surg Am. 2006 Dec;88(12):2637-44.

 


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