Surgical referral criteria for degenerative rotator cuff tears: a Delphi questionnaire study

Selecting the most appropriate patients to refer for surgery is crucial for high-quality and efficient clinical care. However, there are no specific referral criteria to guide the referral of appropriate patients for rotator cuff repair surgery. The aim of the present study was to design robust surgical referral criteria for patients with degenerative rotator cuff tears using consensus methodology. A two-round Delphi questionnaire was undertaken with a nationally representative sample of 41 specialist shoulder surgeons experienced in rotator cuff repair. Surgical referral criteria for degenerative rotator cuff tear were developed where consensus of at least 70% agreement was achieved. The initial questionnaire consisted of 24 items. Consensus was reached on 14 items, including: severity of pain, functional limitation, the identification of fat atrophy, agreement that a course of physiotherapy should be attempted before surgical referral, and exclusion for those with an active frozen shoulder. However, there was no consensus with regard to the dimensions of the tear. The surgical referral criteria developed were novel and promising for patients with degenerative rotator cuff tears, and further research is required to examine their efficacy.