Rotator Cuff Tears Do Not Hurt Capsulolabral Repair Outcomes

In a recent article, “In Throwers With Posterior Instability, Rotator Cuff Tears Are Common but Do Not Affect Surgical Outcomes,”  published in the January 2018 issue of the American Journal of Orthopedics, researchers discovered that concomitant rotator cuff tears do not affect the outcomes of arthroscopic capsulolabral repair for posterior shoulder instability in throwing athletes.

James P. Bradley, M.D., of the Burke and Bradley Orthopedics in Pittsburgh, PA, and colleagues at the start of their study hypothesized that having concomitant rotator cuff repairs while undergoing the surgery would result in poorer outcomes and return to play.

Then they measured preoperative and postoperative outcomes in 56 consecutive throwing athletes with unidirectional posterior shoulder instability who underwent arthroscopic capsulolabral repair performed between January 1998 and December 2009 by Bradley. Outcomes measured included pain, stability, function, range of motion, strength and American Shoulder and Elbow Surgeons Shoulder (ASES) scores, as well as return to play. Patients with and without rotator cuff tears were compared.

According to the results, 24 (43%) of the athletes followed had both rotator cuff pathology and posterior capsulolabral pathology. All rotator cuff repairs were debrided. At a mean of 3.2 years, there was no significant differences in outcomes between both groups. Mean preoperative ASES scores for patients with rotator cuff tears improved significantly (t = –13.8, p < .001) as well as those for patients without the additional pathology (t = –8.9, p < .001). In addition, preoperative stability scores improved in both groups (p < .001). Bradley and colleagues also found that 92% (22/24) of the athletes with concomitant rotator cuff tears were able to return to sport (p = .414) and 67% returned at the same level (p = .430).

Bradley and colleagues wrote, “Arthroscopic capsulolabral reconstruction is successful in throwing athletes with [rotator cuff tears] treated with arthroscopic debridement. Unlike a previous study of throwing athletes’ outcomes after surgery for concomitant [superior labral anterior posterior] SLAP tears and RCTs [rotator cuff tears], this study of throwing athletes with concomitant posterior shoulder instability and RCTs found no difference in patient-reported outcome measures or return to play.”

They added, “There may be discrepancies in interpreting return-to-play between the two studies, but in the current study, 67% of those with concomitant RCTs achieved return to preinjury level of play. This is 10% higher than the rate reported in athletes with SLAP tears alone (57% and even higher than those with concomitant SLAP and RCTs.”