St Pierre, J Shoulder Elbow Surg 2021 - Consensus Statement on the Treatment of Massive Irreparable Rotator Cuff Tears: A Delphi Approach by the Neer Circle of the American Shoulder and Elbow Surgeons

Consensus Statement on the Treatment of Massive Irreparable Rotator Cuff Tears: A Delphi Approach by the Neer Circle of the American Shoulder and Elbow Surgeons

St Pierre, Tokish, et al.·J Shoulder Elbow Surg·2021·40 citations

St Pierre and colleagues used a Delphi survey of the ASES Neer Circle to find where shoulder experts agree on treating massive irreparable rotator cuff tears across defined patient scenarios.

Three‑round Delphi survey of 72 of the 120 Neer Circle members, rating 6 treatments across 60 scenarios. The authors call it level V expert opinion, not a standard of care. Many authors disclose industry royalties or consulting.

Key Consensus Statements

Twenty of the 60 scenarios reached the 90% bar for an acceptable treatment. RSA accounted for 18, all in patients aged 50 to 70 or over 70 with pseudoparesis.
The other 2 acceptable‑treatment scenarios were arthroscopic debridement and/or partial repair, when the subscapularis was intact or reparable, with no pseudoparesis, no dynamic instability and low occupational demand.
RSA was the only treatment to reach 80% agreement as preferred, in 8 scenarios, all with pseudoparesis. Seven of the 8 were patients over 70.
The panel judged RSA not acceptable in 3 scenarios, all in patients under 50 with an intact or reparable subscapularis and no pseudoparesis or dynamic instability.
SCR was judged not acceptable in 4 scenarios, all in patients over 70 with pseudoparesis and an absent or irreparable subscapularis.
The authors chose the 80% and 90% thresholds arbitrarily. At 80% for acceptable treatment, 61 scenarios would have qualified, and at 95% only 10.

Board pearl

Experts weighed dynamic instability and pseudoparesis over patient age. The panel ranked them the two most influential factors in both ranking rounds.

Authors' conclusion

This Delphi process exhibited significant consensus regarding RSA as a preferred treatment strategy in older patients with pseudoparesis, an irreparable subscapularis, and dynamic instability. In addition, the process identified certain unacceptable treatments for MIRCTs such as SCR in older patients with pseudoparesis and an irreparable subscapularis or RSA in young patients with an intact or reparable subscapularis without pseudoparesis or dynamic instability. The publication of these scenarios and areas of consensus may serve as a useful guide for practitioners in the management of MIRCTs.

Supplemental

Consensus Statement on the Treatment of Massive Irreparable Rotator Cuff Tears: A Delphi Approach by the Neer Circle of the American Shoulder and Elbow Surgeons.

St Pierre, Tokish, et al.J Shoulder Elbow Surg202140 citations