Comparison of Functional Outcomes After Arthroscopic Rotator Cuff Repair Between Patients With Traumatic and Atraumatic Tears

Abstract

Background: The role of tear etiology in outcomes after rotator cuff repair is not well understood. Purpose/Hypothesis: The purpose of this study was to determine the difference in outcomes after rotator cuff repair based on tear etiology. We hypothesized that traumatic rotator cuff tears will have greater improvements in functional outcome measures and range of motion (ROM) than atraumatic tears. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a chart review of 221 consecutive patients who underwent arthroscopic rotator cuff repair; prospectively collected preoperative and minimum 2-year postoperative data were evaluated. Shoulder ROM, strength, and standard shoulder physical examination findings were recorded pre- and postoperatively. Outcome measures included visual analog scale for pain, Subjective Shoulder Value (SSV), 10-item Patient-Reported Outcomes Measurement Information System (PROMIS-10; physical and mental components), and American Shoulder and Elbow Surgeons (ASES) form. Results: Of the 221 patients, 73 had traumatic tears and 148 had atraumatic/degenerative tears. There were no differences in age, body mass index, or Charlson Comorbidity Index between groups. Patients in the atraumatic cohort had significantly longer duration of symptoms before presentation (18 vs 7 months; P < .01). Preoperatively, the traumatic cohort had less motion to forward flexion (mean ± SD; 138° ± 43.7° vs 152° ± 29.8°; P = .02). Postoperatively, both groups experienced significant improvements in visual analog scale and SSV scores ( P < .001 each). However, only the traumatic cohort demonstrated improvements in ASES and PROMIS-10 physical component scores. Patients with traumatic rotator cuff tears had lower preoperative SSV and less motion than those with atraumatic tears, but they had greater improvements in SSV (40.6% ± 39.0% vs 29.2% ± 39.7%; P = .005) and forward flexion (21.6° ± 48.6° vs 2.3° ± 48.2°; P < .001), as well as strength in forward flexion, external rotation, and internal rotation ( P < .001, P = .003, and P = .002, respectively). Conclusion: Patients with traumatic rotator cuff tears have worse preoperative symptoms and more functional deficits but experience greater improvements in ROM, strength, and perceived shoulder function than those with degenerative/atraumatic tears.

Comparison of post-operative outcomes in arthroscopic repair of traumatic and atraumatic rotator cuff tears

“…In comparing demographic differences between groups, our findings are consistent with existing research, which also indicated that traumatic or symptomatic RC tears, as a whole, are more common in men (Braune et al 2003;Mall et al 2013). Furthermore, when accounting for mechanism of injury, women were more likely to receive care for degenerative RC tear and men for traumatic RC tear (Godshaw et al 2022;Paul, Yadav, and Goyal 2021;Teratani 2017). Additionally, previous studies suggest that delaying RCR by 4-12 months significantly increases the odds of worse outcomes, including longer recovery time, lesser functional improvements, and increased likelihood of revision surgery (Gutman et al 2021;Hantes et al 2011;Fu et al 2020).…”

“…(Zhao et al 2021). Surgical rotator cuff repair (RCR) plays a vital role in the treatment of over 250,000 patients in the United States each year, and has been shown to effectively reduce pain and improve shoulder function following symptomatic RC tears (Mather et al 2013;Narvani et al 2020;Godshaw et al 2022). Within the aging population, it is expected that the prevalence of RC tears will continue to increase annu-ally -thus, an increasing volume of RCRs will be necessary to compensate for the growing burden (Zhao et al 2021;Karjalainen et al 2019).…”

“…Notably, rotator cuff tears can be classified based on their etiology as either traumatic or atraumatic. Atraumatic tears are believed to be a consequence of aging, occurring when chronic tendon degeneration progresses into partialor full-thickness tears of the RC over time (Godshaw et Comparison of post-operative outcomes in arthroscopic repair of traumatic and atraumatic rotator cuff tears al. 2022;Keener et al 2019;Codding and Keener 2018).…”

“…Asymptomatic RC tears are highly prevalent among elderly populations, most specifically identifiable by weakened shoulder abduction strength during physical exam (Kim et al 2009). Conversely, traumatic tears are the result of highenergy injuries that cause full-thickness tears and acute functional deficits to the shoulder (Godshaw et al 2022;Abdelwahab et al 2021;Loew et al 2015). Several factors that have been shown to be correlated with worse post-operative outcomes following RCR, including patient age, tear size, tear chronicity, and fatty infiltration (Abdelwahab et al 2021;Gladstone et al 2007;Gerber, Fuchs, and Hodler 2000;Harryman et al 1991;Mall et al 2014;Lähteenmäki et al 2006).…”

“…For example, Paul et al and Braune et al demonstrated that functional outcomes are better following RCR for traumatic tears (Paul, Yadav, and Goyal 2021;Braune et al 2003). Conversely, studies by Godshaw et al and Teratani exhibited no difference in post-operative functional measurements between traumatic and atraumatic cohorts (Godshaw et al 2022;Teratani 2017).…”