Current management of impingement syndrome and repairable rotator cuff tears in South Korea: A web-based survey

초록

Background Despite advances in arthroscopic techniques and accumulating clinical evidence, the management of impingement symptoms without a definite rotator cuff tear and repairable rotator cuff tears remains variable in daily practice. Understanding contemporary practice patterns may help identify areas of consensus and variation and inform future guideline development. Methods A nationwide, cross-sectional, web-based survey was conducted among members of the Korean Arthroscopy Society. The full questionnaire consisted of 110 items; the present study analyzed 37 items addressing impingement symptoms without a definite rotator cuff tear, acromioplasty during rotator cuff repair, management of concomitant long head of the biceps pathology, indications and techniques for partial-thickness tears, repair strategies for repairable full-thickness tears, and decision-making for subscapularis tears. Responses were summarized descriptively. Majority consensus was defined as selection by at least half of respondents. Subgroup analyses were performed according to practice setting, comparing university-based and non-university-based surgeons. Results A total of 100 surgeons completed the survey. Most respondents reported that they rarely consider surgery for impingement symptoms without a definite rotator cuff tear and that escalation to surgery is primarily driven by persistent symptoms rather than imaging findings alone. During rotator cuff repair, acromioplasty was commonly performed, typically limited to spur excision. Management of long head of the biceps pathology showed strong consensus, with treatment decisions guided mainly by patient age and activity level and a preference for tenotomy in older patients. For partial-thickness rotator cuff tears, operative thresholds varied, particularly for lower-grade tears; however, when surgery was selected for partial articular-sided lesions, tear completion followed by repair was the most commonly preferred approach. Suture-bridge constructs were strongly favored for repairable full-thickness tears, with tear size, retraction, and tissue quality identified as the primary determinants of construct selection. Practice-setting differences were observed in the timing of escalation from conservative care and in the selective use of biologic adjuncts, including greater use of bioinductive patches for bursal-sided partial-thickness tears in university-based settings. Conclusion This nationwide survey suggests that Korean shoulder surgeons have generally aligned their practice with contemporary evidence by avoiding routine surgery for impingement without a definite tear and by applying anatomy-driven strategies for repairable rotator cuff tears. Persistent variability in operative thresholds for partial-thickness tears and selective use of biologic adjuncts highlights areas where further evidence synthesis and consensus guidance may help reduce practice variation and support standardized, value-based care. Level of evidence Level IV, Cross-sectional survey study

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