Efficacy of postoperative drainage after arthroscopic rotator cuff repair: a randomized controlled trial

BACKGROUND: Arthroscopic rotator cuff repair is the standard treatment in patients with symptomatic reparable rotator cuff tear. It brings good to excellent postoperative outcomes. Postoperative suction drainage is the method to theoretically reduce postoperative shoulder swelling and hematoma formation, which is still commonly used in clinical practice, yet its efficacy remains unproven. METHODS: This is a nonblinded prospective randomized controlled study. A sample of 43 shoulders were simply randomized without replacement across drain and nondrain groups, allocated by sealed envelope before skin closures. The preoperative, intraoperative, and postoperative data were analyzed. The difference of oblique (O) and horizontal (H) shoulder circumference between before and after operation is the primary parameter indicating swelling and hematoma formation. The preoperative reliability of O and H dimensions were evaluated by 2 independent evaluators. The visual analog scale, estimated blood loss, and Disabilities of Arm, Shoulder, and Hand score were analyzed. RESULTS: There was no significant difference of circumference between drain and nondrain groups in both O and H methods. For method O, the mean difference between drain and nondrain groups at 24 hours was -0.25 (95% CI: -2.09 to 1.59, P = .783), at 1 week was -0.54 (95% CI: -2.05 to 0.96, P = .470), at 1 month was -0.39 (95% CI: -2.06 to 1.28, P = .639) and at 3 months was -0.01 (95% CI: -1.49 to 1.46, P = .987). Method H: Mean difference between groups at 24 hours was 0.29 (95% confidence interval [CI]: -0.61 to 1.20, P = .520), at 1 week was 0.004 (95% CI: -0.99 to 1.002, P = .993), at 1 month was -0.53 (95% CI: -1.62 to 0.56, P = .333), and at 3 months was -0.07 (95% CI: -0.91 to 0.77, P = .862). The preoperative O and H parameters showed strong to almost perfect agreement (intraclass correlation coefficient for A = 0.858 [95% CI: 0.738 to 0.923, P < .001], intraclass correlation coefficient for B = 0.955 [95% CI: 0.918 to 0.976, P < .001]). No significant difference of visual analog scale, estimated blood loss, and Disabilities of Arm, Shoulder, and Hand score was recorded between groups. CONCLUSION: No difference was found between drain and nondrain placement for shoulder swelling, visual analog scale, estimated blood loss, and functional outcome in 3 months after surgery. Drain placement after arthroscopic rotator cuff repair is of unproven benefit in routine clinical practice.