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

Overview

Journal Arthrosc Sports Med Rehabil

Date 2025 Mar 5

PMID 40041817

Authors

Gaston Davis

Usman Zareef

Andres Perez

Ryan W Paul

Daniel Givner

Brandon J Erickson

Kevin B Freedman

Steven B Cohen

Fotios P Tjoumakaris

Affiliations

Soon will be listed here.

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 ( ≤ .031) and earlier staging (less than 3 months) ( ≤ .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; < .001) when staged greater than 9 months apart.

Conclusions: Staged RCR has superior functional outcomes, decreased surgical complications, as well as lower revision rates than simultaneous RCR.

Level Of Evidence: Level IV, systematic review of Level II-IV studies.

References

Kim H, Kim J, Rhee Y . When Do Patients Return to Previous Daily Activity After Arthroscopic Rotator Cuff Repair?. Clin Orthop Relat Res. 2019; 477(2):403-413. PMC: 6370080. DOI: 10.1097/CORR.0000000000000554. View

Aleem A, Syed U, Wascher J, Zoga A, Close K, Abboud J . Functional outcomes after bilateral arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2016; 25(10):1668-73. DOI: 10.1016/j.jse.2016.01.027. View

Rhee S, Kim D, Kim S, Jeong H, Oh J . The Clinical Outcomes and Their Associated Factors in Staged Bilateral Arthroscopic Rotator Cuff Repair. Arthroscopy. 2018; 34(10):2799-2807. DOI: 10.1016/j.arthro.2018.06.026. View

Ji X, Bi C, Wang F, Wang Q . Arthroscopic versus mini-open rotator cuff repair: an up-to-date meta-analysis of randomized controlled trials. Arthroscopy. 2014; 31(1):118-24. DOI: 10.1016/j.arthro.2014.08.017. View

Cancienne J, Denard P, Garrigues G, Werner B . The Relationship of Staged, Bilateral Arthroscopic Primary Rotator Cuff Repair Timing and Postoperative Complications. Am J Sports Med. 2021; 49(8):2027-2034. DOI: 10.1177/03635465211015198. View

Erickson B, Ling D, Wong A, Eno J, Dines J, Dines D . Does having a rotator cuff repair prior to reverse total shoulder arthroplasty influence the outcome?. Bone Joint J. 2019; 101-B(1):63-67. DOI: 10.1302/0301-620X.101B1.BJJ-2018-0874.R1. View

Chu J, Shieh J, Wu K, Guan H, Roche S, Held M . Simultaneous or Staged Bilateral Arthroscopic Rotator Cuff Repair: An Observational Study of Intraoperative and Postoperative Outcomes. Orthop J Sports Med. 2021; 9(10):23259671211041994. PMC: 8543723. DOI: 10.1177/23259671211041994. View

Thornton G, Shao X, Chung M, Sciore P, Boorman R, Hart D . Changes in mechanical loading lead to tendonspecific alterations in MMP and TIMP expression: influence of stress deprivation and intermittent cyclic hydrostatic compression on rat supraspinatus and Achilles tendons. Br J Sports Med. 2008; 44(10):698-703. DOI: 10.1136/bjsm.2008.050575. View

Nabeshima Y, Grood E, Sakurai A, Herman J . Uniaxial tension inhibits tendon collagen degradation by collagenase in vitro. J Orthop Res. 1996; 14(1):123-30. DOI: 10.1002/jor.1100140120. View

10.

Giai Via A, De Cupis M, Spoliti M, Oliva F . Clinical and biological aspects of rotator cuff tears. Muscles Ligaments Tendons J. 2013; 3(2):70-9. PMC: 3711705. DOI: 10.11138/mltj/2013.3.2.070. View

11.

Yau W . Differences in Clinical Outcomes Between Patients With Retear After Supraspinatus Tendon Repair and Those With Intact Repair at 5-Year Follow-up. Am J Sports Med. 2024; 52(4):1040-1052. DOI: 10.1177/03635465241227643. View

12.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J . Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003; 73(9):712-6. DOI: 10.1046/j.1445-2197.2003.02748.x. View

13.

Fabricant P, Chin C, Grawe B, Dines J, Craig E, Dines D . Staged bilateral total shoulder arthroplasty: improved outcomes with less than 6 months between surgeries. J Shoulder Elbow Surg. 2016; 25(11):1774-1779. DOI: 10.1016/j.jse.2016.04.004. View

14.

Hein J, Reilly J, Chae J, Maerz T, Anderson K . Retear Rates After Arthroscopic Single-Row, Double-Row, and Suture Bridge Rotator Cuff Repair at a Minimum of 1 Year of Imaging Follow-up: A Systematic Review. Arthroscopy. 2015; 31(11):2274-81. DOI: 10.1016/j.arthro.2015.06.004. View

15.

Wang C, Yang P, Zhang D, Jeon I, Yu T, Zhang Y . Bilateral single-staged arthroscopic rotator cuff repair is comparable to staged procedures: a retrospective follow up study of 2 years. BMC Musculoskelet Disord. 2021; 22(1):409. PMC: 8094466. DOI: 10.1186/s12891-021-04304-7. View

16.

Castagna A, Garofalo R, Conti M, Khair Y, Gumina S, De Giorgi S . Arthroscopic transosseous versus suture anchor repair: clinical outcomes in patients with bilateral rotator cuff tears. J Biol Regul Homeost Agents. 2020; 34(4 Suppl. 3). View

17.

Smith K, Clinker C, Cutshall Z, Lu C, Joyce C, Chalmers P . Progression of symptomatic bilateral rotator cuff disease. JSES Int. 2023; 7(4):586-591. PMC: 10328764. DOI: 10.1016/j.jseint.2023.04.005. View

18.

Morris B, Haigler R, OConnor D, Elkousy H, Gartsman G, Edwards T . Outcomes of staged bilateral reverse shoulder arthroplasties for rotator cuff tear arthropathy. J Shoulder Elbow Surg. 2014; 24(3):474-81. DOI: 10.1016/j.jse.2014.08.008. View

19.

Kuhn J . Nonoperative Treatment of Rotator Cuff Tears. Am J Orthop (Belle Mead NJ). 2016; 45(2):66-7. View

20.

Weekes D, Campbell R, Allegretto J, Lopez S, Pepe M, Tucker B . A Prospective Study of Patient Factors and Decision-making for Surgical Repair of Symptomatic Full-Thickness Rotator Cuff Tears. Orthopedics. 2019; 43(2):85-90. DOI: 10.3928/01477447-20191223-02. View