乌鸦传媒

LAS VEGAS -- Medicare patients who underwent acromioplasty in conjunction with rotator cuff reconstruction were more likely, not less, to need reoperation within 5 years, researchers found.

In what is likely the largest analysis conducted to date, covering some 80,000 Medicare beneficiaries, 8.5% of patients having both procedures needed repeat cuff repair within 5 years, compared with 6.8% of patients undergoing cuff reconstruction alone (P<0.001), according to John Mueller, MD, of Columbia University in New York City.

Five-year rates of all types of shoulder reoperation differed similarly, at 9.6% with the dual procedures versus 9.1% for rotator cuff repair alone (P<0.001), Mueller told attendees at the American Academy of Orthopaedic Surgeons annual meeting.

The findings will surely fuel renewed debate over the value of acromioplasty as an adjunct to rotator cuff repair, which remains extremely common despite growing controversy.

Mueller explained that acromioplasty is intended to "eliminate external compression on the rotator cuff [and to] improve working space and visualization." Since it was first proposed in 1972, it has grown and is included in a majority of rotator cuff repair surgeries.

In recent years, however, have suggested that this extra procedure has . On the other hand, a long-term analysis of patients participating in a randomized trial, published last December with more than 11 years of mean follow-up, found in patients who did not have acromioplasty.

Yet that didn't settle the question, either. A accompanying that paper pointed out that attrition was high during follow-up and indications for reoperation were not standardized.

"The data from this investigation reopen the discussion of what the utility of an acromioplasty is during rotator cuff repair and actually pose more questions than answers," wrote the commentary author, Michael Khazzam, MD, of the University of Texas Southwestern Medical Center in Dallas.

One important difference in this analysis, Mueller said, is that by examining the Medicare population, it covers all procedures irrespective of the surgeon's specialty. Previous studies, he said, have focused on shoulder subspecialists; whereas in the real world, most such procedures are done by general orthopedic surgeons.

Mueller and colleagues searched Medicare records for codes indicating rotator cuff reconstruction with or without acromioplasty. They identified 54,209 cuff repair procedures that included acromioplasty from 2005 to 2014 that were matched 2:1 by age, sex, date of initial procedure, and comorbidity score 26,448 performed without it. The researchers then looked for subsequent ipsilateral shoulder surgeries over the following 5 years.

About 57% in both groups were ages 65-74, and the patients were evenly divided between men and women.

Rates of revision surgery were equal in the two groups through the first year and then diverged, increasing more in the group who had acromioplasty.

Mueller said future research should entail "longitudinal multi-center trials with patient-reported outcomes," which also include "more individual surgeon- and patient-specific indications" for acromioplasty.

One limitation of his study, he observed, is that it was unclear why acromioplasty was chosen in individual cases. It remains possible that patients who clinicians believed would benefit from it were nevertheless already more likely to suffer repair failure and that acromioplasty was unable to fully prevent it.

Another important point, Mueller said, is that the Medicare data don't specify the acromioplasty technique, which could influence outcomes.

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