Earlier repair of traumatic rotator cuff tears linked to better outcomes
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Earlier repair of full-thickness traumatic rotator cuff tears is associated with better improvement and overall functional outcomes, according to results of a recently presented study.
“We recommend that repair within 4 months of injury is the optimal timing,” Matthew L. Ramsey, MD, said during the virtual American Shoulder and Elbow Surgeons Annual Meeting.
In the retrospective study, Ramsey and colleagues studied data on patients who had repair of acute traumatic rotator cuff tears to determine how functional outcomes are affected by surgical timing and to establish a threshold time to repair for optimal outcomes.
Patients who developed acute symptoms after a legitimate traumatic event and were found to have a full-thickness rotator cuff tear were recorded. Patients had surgical repair within 12 months of the injury and preoperative functional scores. After removing patients without adequate imaging and preoperative scores, 1,064 charts were reviewed. Overall, 257 patients meet the inclusion criteria after verifying traumatic injury and MRI review, of which 206 patients were available for the 2-year postoperative follow-up.
Average patient age was 60 years, with 150 men and 56 women. Follow-up was 35.5 months, and 12.1% of patients had an active workers compensation claim. Patients were categorized into the following four groups based on time from injury to rotator cuff repair: less than 2 months; 2 to 4 months; 4 to 6 months; and 6 to 12 months.
Outcome measures were tear characteristics, which included tear size and global fatty degeneration index. Functional outcome scores were ASES, simple shoulder test (SST) and VAS pain scores and the single assessment numeric evaluation. Failure was defined as symptomatic retears based on MRI or intraoperative evidence of tear or reoperation.
Ramsey said that when taking tear size and workers compensation status into account, repair within 4 months of injury resulted in 10.3-point improvement in ASES score and 1.8-point improvement in SST score.
“In this patient cohort, larger and more debilitating traumatic rotator cuff tears were repaired earlier than small tears. However, all patients improved following surgery and exceeded the published minimal clinical important difference for ASES and SST scores,” he said.
Perspective
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Michael McKee, MD, FRCS(C)
The main advantage of this study by Ramsey and colleagues is that it is a large series dealing specifically with acute, traumatic cuff tears. The previous literature on this topic is limited by poor methodology, small numbers and/or the inclusion of acute tears in larger series of patients with subacute or chronic cuff pathology. As common sense would suggest, this study shows the earlier an acute cuff tear is repaired, the better the outcome. This was both statistically significant and clinically relevant (10 points on the ASES outcome score).
It is important to remember that patients with an acute tear from a specific injury are a minority of the typical “cuff” population (only 20% of potential patients seen were included). This study clearly suggests that earlier identification, and repair, of this specific type of injury is probably beneficial for the patient. This is despite the bias in the study in that the larger and more symptomatic tears were identified earlier and thus would predispose the “earlier repair” group to a more negative outcome.
In summary, in my opinion, this study clearly supports the aggressive identification and surgical treatment of this specific subset of patients.
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Ramsey ML, et al. Paper 1. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 2-3, 2020 (virtual meeting).
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