ArticleJSES international2026
Infection following primary rotator cuff repair - Prophylaxis, diagnosis, and management - an international expert Delphi consensus statement.
Article in JSES international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
Background: The purpose of this study was to establish consensus statements on the diagnosis, prophylaxis, and treatment of infections following primary rotator cuff repair (RCR). Methods: A Delphi consensus process on the diagnosis, prophylaxis, and treatment of infections following primary RCR was conducted with 56 shoulder/sports surgeons from North America and Europe with at least 10 years of experience in RCR. Consensus was defined as achieving 80-89% agreement, whereas strong consensus was defined as 90-99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement. Results: A total of 32 statements were evaluated. Regarding diagnosis, consensus outcomes included 1 unanimous, 4 strong consensus, 2 consensus, and 3 statements without consensus. For prophylaxis, 2 statements reached strong consensus, 1 reached consensus, and 2 did not achieve consensus. In acute infection management, 5 statements reached strong consensus, 1 reached consensus, and 2 did not reach consensus. For chronic infection management, 4 statements achieved strong consensus, 2 reached consensus, and 1 did not achieve consensus. Regarding negative versus positive cultures, 3 statements reached strong consensus and 1 reached consensus. For staged revision procedures, 2 statements reached consensus. Conclusion: This international Delphi study achieved strong consensus or consensus on most aspects of infection management following primary RCR, including diagnostic signs, laboratory tests, imaging, preferred prophylaxis with a single pre-operative IV dose of cefazolin, and surgical approach for acute and chronic infections. Strong consensus supported empiric treatment of culture-negative pathogens, withholding antibiotics until cultures are obtained when feasible and delaying revision 6-12 weeks after antibiotic treatment completion. Areas without consensus included surgical management in acute infection with high virulence organisms using a staged procedure, attempting hardware retention in chronic infections even with low virulence organisms, the routine use of vancomycin powder in RCR, and pre-operative oral antibiotics as a method of prophylaxis.
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