Surgical Positioning in Arthroscopic Rotator Cuff Repair: Comparable Outcomes but Longer Operative Times in the Beach-Chair Position

Background: Arthroscopic rotator cuff repair (RCR) can be performed with patients in either the lateral decubitus (LDP) or beach-chair position (BCP). There are limited data exploring the effect of patient positioning on outcomes after RCR. Hypothesis: There will be a difference in patient-reported outcomes (PROs) between patients who underwent arthroscopic RCR in LDP versus BCP, and a significantly shorter operating room time in LDP to account for positioning. Study Design: Cohort study: Level of evidence, 3. Methods: Patients were propensity score matched for tear size and demographic variables including age, body mass index, sex, and workers’ compensation status. Patients were included who had an isolated arthroscopic primary RCR with ≥2 years of PRO data available. Results: A total of 160 patients, 80 in each of LDP and BCP, were included in the study. There were no significant differences in American Shoulder and Elbow Surgeons function scores, and both groups improved at 2 years from 14.0 to 26.2 (95% CI, 12.7-15.3; 25.1-27.3) in BCP and 13.9 to 25.8 (95% CI, 24.8-26.9) in LDP ( P = .64). No significant differences were found in PRO measures, including Single Assessment Numeric Evaluation score, Simple Shoulder Test, and Veterans RAND 12-Item Health Survey (VR-12) Physical Component Summary. The VR-12 Mental Component Summary score improved from 0 to 24 months with the BCP group scoring significantly better than LDP ( P < .05). No difference in surgical time from incision to close was identified (BCP, 87.4 ± 23.1 minutes; LDP, 82.4 ± 31.4 minutes; P = .30); however, BCP cases had significantly longer total operating room time from in-room to end of procedure (BCP, 122.3 ± 25.7 minutes; LDP, 110.7 ± 30.3 minutes; P = .038). Two-year complication rates were similar between groups and identified in 9 (11.3%) patients in the BCP group and 11 (13.8%) patients in LDP ( P = .63). Conclusion: Overall, PROs and complication rates were largely equivocal between the 2 groups at 2 years. Total operative time was shorter with LDP, reflecting the effect of setup for BCP. Patient positioning does not appear to affect patient outcomes, and surgeons should pick the positioning they are most facile with performing arthroscopic RCR.