The American Academy of Orthopaedic Surgeons has released a guideline and recommendations on rotator cuff repair.
The organization made 14 recommendations on operative and non-operative treatment of rotator cuff injuries and conditions. The guidelines and recommendations were issued after considering several recent studies and articles on the subject.
The recommendations include:
1. Full thickness tears and asymptomatic patients. In the absence of reliable evidence, the work group suggests non-operative treatment for asymptomatic, full thickness rotator cuff tears.
2. Full thickness tears and symptomatic patients. Rotator cuff repair is an option for patients with chronic, symptomatic full thickness tears.
3. Rotator cuff tears and exercise. The work group does not recommend for or against exercise programs for patients with rotator cuff tears.
4. Rotator cuff tears and corticosteroid injections. The work group does not recommend for or against subacromial injections for patients with rotator cuff tears.
5. Rotator cuff tears and NSAIDS, activity modification, ice, heat, iontophoresis, massage, TENS, PEMF and phonophoresis. The workgroup doesn’t recommend for or against the use of NAIDS, activity modification, ice, heat, iontophoresis, massage, Transcutaneous Electrical Nerve Stimulation, Puled Electomagnetic Field or phonophoresis for non-operative pain management of rotator cuff tears.
6. Rotator cuff-related symptoms. The workgroup suggests patients who have rotator cuff-related symptoms without a full thickness tear are treated initially nonoperatively using exercise and/or non-steriodal anti-inflammatory drugs. The group does not recommend for or against subacromial corticosteroid injection, PEMF, TENS, iontophoresis, phonophoresis, ice, heat, massage or activity modification for treating rotator cuff-related symptoms.
7. Acute traumatic rotator cuff tears and surgery. Early surgical repair after an acute injury is an option for patients with rotator cuff tears, but the recommendation from the group is weak.
8. Perioperative interventions. The group does not recommend for or against using perioperative subacromial corticosteroid injections or non-steroidal anti-inflammatory medication for patients undergoing rotator cuff surgery.
9. Confounding factors. The work group says that physicians can advise that increasing age, MRI tear characteristics and workers’ compensation status correlate with less favorable outcomes for rotator cuff surgery. The group does not recommend for or against advising against other confounding factors, such as diabetes, co-morbidities, smoking, prior shoulder infection and cervical disease.
10. Surgery. The group suggests routine acromioplasty isn’t required at the time of rotator cuff repair. There is a weak recommendation for performing partial rotator cuff repair, debridement or muscle transfer for patients with irreparable rotator cuff tears. The recommendation is also weak for surgeons to attempt to achieve bone healing of the cuff in all patients undergoing rotator cuff repair.
The group doesn’t recommend for or against the preferential use of suture anchors versus bone tunnels for repairing rotator cuff tears. The group doesn’t recommend for or against arthroscopic, mini-open or open repair.
The group recommends against using non-crosslinked, porcine small intestine submucosal xenograft patches to treat rotator cuff tears. The group doesn't recommend for or against using soft tissue allografts and other xenografts to treat patients with rotator cuff tears.
11. Post-operative treatment. The work group agrees that local cold therapy is beneficial to relive pain after rotator cuff surgery. The group does not recommend for or against preferential use of abduction pillow versus a standard sling after rotator cuff repair.
12. Post-operative rehabilitation. The group does not recommend for or against a specific time interval prior to initiation of active resistance exercises after rotator cuff repair. The same recommendation is given for a specific timeframe of shoulder immobilization without range of motion exercises after surgery. It remains unclear whether home-based exercise programs or facility-based rehabilitation is more beneficial after rotator cuff surgery.
13. Infusion catheters. The group doesn’t recommend for or against the use of indwelling subacromial infusion catheter for pain management after surgery.
Read more about the AAOS guideline and recommendations concerning rotator cuff repair.
Read more about rotator cuff repair:
- Study Examines Important Factors in Double-Row Rotator Cuff Repair Outcomes
- Arthroscopic Rotator Cuff Repair: Great Outcomes for Patients Over 70
The organization made 14 recommendations on operative and non-operative treatment of rotator cuff injuries and conditions. The guidelines and recommendations were issued after considering several recent studies and articles on the subject.
The recommendations include:
1. Full thickness tears and asymptomatic patients. In the absence of reliable evidence, the work group suggests non-operative treatment for asymptomatic, full thickness rotator cuff tears.
2. Full thickness tears and symptomatic patients. Rotator cuff repair is an option for patients with chronic, symptomatic full thickness tears.
3. Rotator cuff tears and exercise. The work group does not recommend for or against exercise programs for patients with rotator cuff tears.
4. Rotator cuff tears and corticosteroid injections. The work group does not recommend for or against subacromial injections for patients with rotator cuff tears.
5. Rotator cuff tears and NSAIDS, activity modification, ice, heat, iontophoresis, massage, TENS, PEMF and phonophoresis. The workgroup doesn’t recommend for or against the use of NAIDS, activity modification, ice, heat, iontophoresis, massage, Transcutaneous Electrical Nerve Stimulation, Puled Electomagnetic Field or phonophoresis for non-operative pain management of rotator cuff tears.
6. Rotator cuff-related symptoms. The workgroup suggests patients who have rotator cuff-related symptoms without a full thickness tear are treated initially nonoperatively using exercise and/or non-steriodal anti-inflammatory drugs. The group does not recommend for or against subacromial corticosteroid injection, PEMF, TENS, iontophoresis, phonophoresis, ice, heat, massage or activity modification for treating rotator cuff-related symptoms.
7. Acute traumatic rotator cuff tears and surgery. Early surgical repair after an acute injury is an option for patients with rotator cuff tears, but the recommendation from the group is weak.
8. Perioperative interventions. The group does not recommend for or against using perioperative subacromial corticosteroid injections or non-steroidal anti-inflammatory medication for patients undergoing rotator cuff surgery.
9. Confounding factors. The work group says that physicians can advise that increasing age, MRI tear characteristics and workers’ compensation status correlate with less favorable outcomes for rotator cuff surgery. The group does not recommend for or against advising against other confounding factors, such as diabetes, co-morbidities, smoking, prior shoulder infection and cervical disease.
10. Surgery. The group suggests routine acromioplasty isn’t required at the time of rotator cuff repair. There is a weak recommendation for performing partial rotator cuff repair, debridement or muscle transfer for patients with irreparable rotator cuff tears. The recommendation is also weak for surgeons to attempt to achieve bone healing of the cuff in all patients undergoing rotator cuff repair.
The group doesn’t recommend for or against the preferential use of suture anchors versus bone tunnels for repairing rotator cuff tears. The group doesn’t recommend for or against arthroscopic, mini-open or open repair.
The group recommends against using non-crosslinked, porcine small intestine submucosal xenograft patches to treat rotator cuff tears. The group doesn't recommend for or against using soft tissue allografts and other xenografts to treat patients with rotator cuff tears.
11. Post-operative treatment. The work group agrees that local cold therapy is beneficial to relive pain after rotator cuff surgery. The group does not recommend for or against preferential use of abduction pillow versus a standard sling after rotator cuff repair.
12. Post-operative rehabilitation. The group does not recommend for or against a specific time interval prior to initiation of active resistance exercises after rotator cuff repair. The same recommendation is given for a specific timeframe of shoulder immobilization without range of motion exercises after surgery. It remains unclear whether home-based exercise programs or facility-based rehabilitation is more beneficial after rotator cuff surgery.
13. Infusion catheters. The group doesn’t recommend for or against the use of indwelling subacromial infusion catheter for pain management after surgery.
Read more about the AAOS guideline and recommendations concerning rotator cuff repair.
Read more about rotator cuff repair:
- Study Examines Important Factors in Double-Row Rotator Cuff Repair Outcomes
- Arthroscopic Rotator Cuff Repair: Great Outcomes for Patients Over 70