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Updated: May 24, 2025
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
In Patients With Bilateral Rotator Cuff Tear, Staged Surgery is Superior to Simultaneous Surgery: A Systematic Review
Gaston Davis1, Usman Zareef2, Andres Perez1
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A.
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 (P ≤ .031) and earlier staging (less than 3 months) (P ≤ .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; P < .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.