In Patients With Bilateral Rotator Cuff Tear, Staged Surgery is Superior to Simultaneous Surgery: A Systematic Review

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-02-01 DOI:10.1016/j.asmr.2024.101033

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.