High degree of consensus on diagnosis and management of rotator cuff tears: a Delphi approach.

Autor: Saccomanno MF; Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy. maristellasaccomanno@hotmail.it.; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. maristellasaccomanno@hotmail.it., Lisai A; Humanitas San Pio X, Milan, Italy., Romano AM; Casa di Cura Maria Rosaria, Naples, Italy., Vitullo A; Clinica Ars Medica, Rome, Italy., Pannone A; Policlinico 'Città di Udine', Udine, Italy., Spoliti M; Orthopaedics and Traumatology Unit, Department Emergency and Acceptance, San Camillo Forlanini Hospital, Rome, Italy., Di Giunta ACC; Policlinico 'G.B. Morgagni' Catania, Catania, Italy., Castricini R; Orthopedics and Traumatology Unit, Villa Verdi Hospital, Fermo, Italy., Giordano MC; Villa Betania GIOMI, Rome, Italy.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2023 Oct; Vol. 31 (10), pp. 4594-4600. Date of Electronic Publication: 2023 Jul 31.
DOI: 10.1007/s00167-023-07501-0
Abstrakt: Purpose: To develop a consensus on diagnosis and treatment of rotator cuff tears. The study focused on selected areas: imaging, prognostic factors, treatment options, surgical techniques.
Methods: Panel was composed of all members of the shoulder committee of the Italian Society of Arthroscopy, Knee, Upper arm, Sport, Cartilage and Orthopedic techniques (SIAGASCOT). Four rounds were performed. The first round consisted of gathering questions which were then divided into seven blocks referring to: imaging, patient-related prognostic factors, treatment options, surgical steps, reparative techniques, surgical predictive factors, advanced techniques. Subsequent rounds consisted of condensation by means of online questionnaire and debates. Consensus was defined as two-thirds agreement on one answer. Descriptive statistic was used to summarize the data.
Results: Forty-one shoulder experts were involved. Fifty-six statements were finally formulated. A consensus could be achieved on 51. Experts agreed that preoperative magnetic resonance imaging is strongly recommended because it allows a careful evaluation of tear characteristics, while the role of US remains debatable. Controversial patient-related factors such as age, comorbidities, smoking and stiffness do not contraindicate the repair. From a surgical standpoint, the experts highlighted that pseudo-paralysis is not a contraindication to rotator cuff repair. Consensus on specific surgical steps was also achieved: capsular release should be performed only in stiff shoulders; footprint preparation is mandatory, while debridement of tendon edges is not essential. If necessary, a rotator interval release could be performed without interrupting the continuity between subscapularis and supraspinatus tendon; posterior delamination should be always included in the repair. Advanced techniques such as tendon transfers should be selected based on the main clinical deficit, while the superior capsule reconstruction plays a role only in combination with a functional repair.
Conclusion: A consensus was achieved almost on every topic of controversy explored. Particularly, MRI was deemed necessary to determine tear characteristics, while radiographs remain important for differential diagnosis; age should not be considered a contraindication to surgery; pseudo-paralysis does not represent a contraindication to arthroscopic rotator cuff repair, but superior capsule reconstruction plays a role only in combination with a functional repair. Latissimus dorsi transfer plays a role when the main functional deficit is in elevation, while the lower trapezius transfer plays a role when the main functional deficit is the external-rotation.
Level of Evidence: V.
(© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)
Databáze: MEDLINE
Externí odkaz: