Concomitant Subacromial Decompression Remains Commonly Performed During Rotator Cuff Repair: A Trinetx Study

Introduction: Arthroscopic rotator cuff repair (RCR) is among the most frequently performed shoulder procedures in the US and is often accompanied by concomitant subacromial decompression (SAD). In recent years some studies have called into question the benefit of SAD in this setting. The topic is controversial as many surgeons still feel SAD is indicated. This study aims to characterize the changes in proportion of SAD performed concomitantly with RCR over recent years using TriNetX. Methods: The TriNetX database was queried for all patients undergoing arthroscopic rotator cuff repair from 2013 to 2025. Cohorts were established using the Current Procedural Terminology procedure codes for RCR (29827) and SAD (29826). Annual incidence of each procedure was determined by TriNetX, and the annual incidence proportion was calculated using the annual RCR incidence number. Trends in the proportion of SAD over time were analyzed with linear regression and an alpha=0.05. Results: The annual number of patients undergoing arthroscopic rotator cuff repair in the TriNetX database ranged from 4,222 to 14,139. Over this period, the proportion of cases with concomitant subacromial decompression decreased significantly from 78.7% to 68.8%. Linear regression analysis demonstrated a significant downward trend in the utilization of concomitant SAD over time (p < .0001). Conclusions: Despite a modest decline in reported utilization, concomitant subacromial decompression remains commonly performed during rotator cuff repair, suggesting continued surgeon confidence in its selective use. The observed decrease may reflect changes in coding practices rather than a true reduction in operative utilization.