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. 2019 May 28;7(5):2325967119845912.
doi: 10.1177/2325967119845912. eCollection 2019 May.

Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015

Avinesh Agarwalla  1 , Gregory L Cvetanovich  2 , Anirudh K Gowd  3 , Anthony A Romeo  4 , Brian J Cole  5 , Nikhil N Verma  5 , Brian Forsythe  5
Affiliations

Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015

Avinesh Agarwalla et al. Orthop J Sports Med. .

Abstract

Background: Rotator cuff injuries are a leading cause of shoulder disability among adults. Surgical intervention is a common treatment modality; however, conservative management has been described for the treatment of rotator cuff tears. As the cost of health care increases, the industry has shifted to optimizing patient outcomes, reducing readmissions, and reducing expenditure. In 2010, the American Academy of Orthopaedic Surgeons created clinical practice guidelines (CPGs) to guide the management of rotator cuff injuries. Since their publication, there have been several randomized controlled trials assessing the management of rotator cuff injuries.

Purpose: To quantitatively describe changes in the management of full-thickness rotator cuff tears over time with regard to the publication of the CPGs and prospective clinical trials.

Study design: Cohort study; Level of evidence, 3.

Methods: Included in the study were Humana-insured patients in the PearlDiver database with the diagnosis of a full-thickness rotator cuff tear from 2010 to 2015. Patients undergoing rotator cuff repair (CPT-29827, CPT-23410, CPT-23412, CPT-23420) and patients undergoing nonoperative management in the queried years were identified. The incidence of physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections was assessed.

Results: In 2015, patients with full-thickness rotator cuff tears were less likely to receive a corticosteroid injection (16.5% vs 23.9%, respectively; odds ratio [OR], 0.6; P < .001) or undergo PT (7.8% vs 12.1%, respectively; OR, 0.6; P < .001) before rotator cuff repair in comparison with 2010. Additionally, patients were no more likely to be prescribed NSAIDs before rotator cuff repair in 2015 in comparison with 2010 (OR, 1.0; P = .6). Patients with full-thickness rotator cuff tears were less likely to undergo acromioplasty in 2015 in comparison with 2010 (48.2% vs 76.9%, respectively; OR, 0.4; P < .001); however, the rate of concomitant biceps tenodesis slightly increased (14.8% vs 14.6%, respectively; OR, 1.1; P = .01).

Conclusion: From 2010 to 2015, there were changes in the management of full-thickness rotator cuff tears, including decreased preoperative utilization of corticosteroid injections and PT as well as a decrease in concomitant acromioplasty, and the rate of biceps tenodesis slightly increased. As CPGs and prospective investigations continue to proliferate, management practices of patients with full-thickness rotator cuff tears continue to evolve.

Keywords: acromioplasty; biceps tenodesis; clinical practice guidelines; rotator cuff repair; value-based care.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: G.L.C. has received research support from Arthrex and educational support from Medwest and Smith & Nephew. A.A.R. has received consulting fees and receives royalties from Arthrex. B.J.C. has received research support from Aesculap/B. Braun, Arthrex, Geistlich, Sanofi-Aventis, and Zimmer Biomet; consulting fees from Anika Therapeutics, Arthrex, Bioventus, Flexion, Geistlich, Genzyme, Pacira, Smith & Nephew, Vericel, and Zimmer Biomet; nonconsulting fees from Arthrex, LifeNet Health, and Pacira; educational support from Arthrex; hospitality payments from GE Healthcare; receives royalties from Arthrex, DJO, and Elsevier; and has stock options in Aqua Boom, Biometrix, Giteliscope, Ossio, and Regentis. N.N.V. has received research support from Arthrex, Arthrosurface, DJO, Ossur, Athletico, ConMed Linvatec, Miomed, and Mitek; consulting fees from Arthrex, Medacta, Minivasive, OrthoSpace, and Smith & Nephew; nonconsulting fees from Pacira; educational support from Medwest; receives royalties from Arthroscopy, Smith & Nephew, and Vindico Medical Education–Orthopedics Hyperguide; and has stock options in CyMedica, Minivasive, and Omeros. B.F. has received research support from Arthrex, Arthrosurface, DJO, Ossur, Smith & Nephew, and Stryker; educational support from Medwest, Smith & Nephew, and Ossur; consulting fees from Arthrex, Sonoma Orthopedics, and Stryker; speaking fees from Arthrex; receives royalties from Arthrex and Saunders/Mosby-Elsevier; and has stock options in Jace Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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