Patients undergoing rotator cuff repair typically have a diagnostic evaluation and trial of nonoperative therapy before surgery. Recent studies have evaluated the cost-effectiveness of surgery, but none have attempted to estimate the costs associated with the preoperative evaluation. This study used available data to examine major expenditures during the preoperative period.

We conducted a search using an insurance company database to identify patients undergoing rotator cuff repair from 2004 to 2009. Patients were identified by the common Current Procedural Terminology codes for rotator cuff repair. The associated charge codes for the 90-day period before surgery were categorized as outpatient physician visits, diagnostic imaging studies, injections, physical therapy, laboratory and other preoperative studies, prior surgeries, and miscellaneous. The frequency of each code and the associated charges were noted.

In total, 92,688 patients were identified in the study period. A total of $161,993,100 was charged during the preoperative period, for an average of $1,748 per patient. Diagnostic imaging charges totaled $104,510,646 (65%); injections, $5,145,227 (3%); outpatient visits, $29,723,751 (18%); physical therapy, $13,844,270 (8.5%); preoperative studies, $6,792,245 (4.2%); and miscellaneous, $1,164,688 (<1%).

The costs for preoperative evaluation of rotator cuff tears are substantial, and the majority of the costs are associated with magnetic resonance imaging. To help reduce costs, future studies should attempt to identify the factors that predict which patients might not respond to nonoperative management and might benefit from early surgical intervention. In addition, magnetic resonance imaging should perhaps be reserved for patients in whom the diagnosis cannot be achieved by other modalities.

Access to orthopaedic care for pediatric patients has been shown in previous studies to be decreased for patients with Medicaid compared with those with private insurance. The relationship between type of insurance and access to care for adult patients with acute rotator cuff tears has not yet been examined. This study aimed to determine if type of health insurance would have an impact on access to care for an adult patient with an acute rotator cuff tear.

Seventy-one orthopaedic surgery practices within the state of North Carolina were randomly selected and contacted on 2 different occasions separated by 3 weeks. The practices were presented with an appointment request for a fictitious 42-year-old man with an acute rotator cuff tear. Insurance status was reported as Medicaid for the first call and as private insurance during the second call.

Of the 71 practices contacted, 51 (72%) offered the patient with Medicaid an appointment, whereas 68 (96%) offered the patient with private insurance an appointment. The difference in these rates was statistically significant (P < .001). The likelihood of patients with private insurance obtaining an appointment was 8.8 times higher than that of patients with Medicaid (95% CI: 2.5, 31.5).

For patients with acute rotator cuff tears, access to care is decreased for those with Medicaid compared with those with private insurance. Patients with private insurance are 8.8 times more likely than those with Medicaid to obtain an appointment.

Basic science, survey study.

The purpose of this study was to determine whether a preoperative radiologic assessment of the coracoid process is predictive of the amount of bone available for coracoid transfer by the Latarjet procedure.

Thirty-five patients with anterior instability undergoing a Latarjet procedure were included. A preoperative radiologic assessment was performed with the Bernageau and true anteroposterior (true AP) views.

The length of the coracoid process was measured on both radiographic views and the values were compared with the length of the bone block during surgery. Statistical analysis was carried out by ANOVA and Wilcoxon tests (P < .05).

On radiologic examination, the mean coracoid process length was 29 ± 4 and 33 ± 4 mm on the Bernageau and true AP views, respectively. The mean bone block length during surgery was 21.6 ± 2.7 mm. A significant correlation was found (P = .032) between the coracoid process length on the true AP view and the intraoperative bone block length.

Preoperative planning for the Latarjet procedure, including graft orientation and screw placement, requires knowledge of the length of coracoid bone available for transfer. This can be facilitated with the use of preoperative standard radiographs, thus avoiding computed tomography. This planning allows the detection of coracoid process anatomic variations or the analysis of the remaining part of the coracoid process after failure of a first Latarjet procedure to avoid an iliac bone graft.

Radiologic preoperative coracoid process measurement is an easy, reliable method to aid preoperative planning of the Latarjet procedure in primary surgery and reoperations.

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