Longer time to surgery for rotator cuff tear did not increase retear rate
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CHICAGO — Surgery for rotator cuff tear performed more than 12 months from symptom onset did not increase retear rate or the likelihood of a second surgery, according to results presented here.
Logan Finger, BS, and colleagues categorized 143 patients with atraumatic rotator cuff tears and at least 1-year postoperative follow-up into groups based on duration of time between symptom onset and surgery, either less than 12 months (early group; n=78) or more than 12 months (late group; n=65).
“Our primary outcomes of interest were retear, defined as symptomatic retear diagnosed with postoperative imaging, or revision repair,” Finger said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “Secondary outcomes included objective measures of range of motion and strength, and patient-reported outcomes, including VAS pain scale, subjective shoulder score and [American Shoulder and Elbow Surgeons] scores.”
Finger noted the early and late groups had no significant differences in terms of patient demographics or tear characteristics. He added the two groups had no significant differences in retear rate, reoperation rate, postoperative range of motion in any plane, strength in external rotation and internal rotation, VAS or subjective shoulder score.
“The early group was, however, more likely to experience an increase in forward flexion strength with no other differences identified for range of motion and strength,” Finger said.
Perspective
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Full-thickness rotator cuff tears are one of the most common and yet potentially challenging diagnoses that many orthopedic surgeons regularly treat. As the body of literature grows to improve our understanding on how best to treat this condition, presentations like this can add value. There are many known risk factors for retear, including increasing tear size, fatty atrophy, age and diabetes, among others.
This presentation concludes there are no differences between early and late repair (defined by duration of symptoms), contradicting the results of a recent meta-analysis. The important point to consider is that between the patient groups, there were no differences in demographics but, more importantly, tear characteristics. This would imply, pending further research, that the characteristics of the tear and/or demographics are more important in the decision-making process than duration of symptoms. This would also potentially indicate, with all else being equal, that adequate trials of conservative care prior to consideration of operative intervention would not result in worse outcomes. Ultimately, this presentation contributes to the growing body of work that may help us develop predictive models to optimize both nonsurgical, as well as surgical, outcomes.
Reference:
Zhao J, et al. J Shoulder Elbow Surg. 2021;doi:10.1016/j.jse.2021.05.010.
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Lin A, et al. Paper 371. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 22-26, 2022; Chicago.
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