Early repair of traumatic rotator cuff tears improves functional outcomes

Gutman, Michael; Joyce, Christopher D.; Patel, Manan S.; Kirsch, Jacob M.; Gutman, Brian; Abboud, Joseph A.; Namdari, Surena; Ramsey, Matthew L.

doi:10.1016/j.jse.2021.03.134

Cited by 39 publications

(45 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While numerous studies have demonstrated worse clinical outcomes for patients with a longer interval between symptom onset and repair in the traumatic tear setting, there is no clear consensus on the effect of treatment timing in the atraumatic setting. 6,11,12,21,28,30,36 The patients in our study with traumatic rotator cuff tears sought care sooner (6.5 vs 17.9 months; P < .01) and underwent operative intervention sooner (57 vs 93 days; P < .01) (Table 1) when compared with those with atraumatic tears. However, this length of symptoms before presentation raises the question of whether a portion of the acute tears were actually acute on chronic, with some degree of prior rotator cuff damage.…”

Section: Discussionmentioning

confidence: 81%

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

Godshaw

Hughes

Boden

et al. 2022

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 81%

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

Godshaw

Hughes

Boden

et al. 2022

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…Some authors advocate for early surgical intervention, as the tissue is usually more robust and allows for optimal healing. 17,45 The 2006 Swedish national guidelines recommend treatment within 3 weeks of injury, despite a notable paucity of literature supporting this assertion. 7 On the contrary, Bjo ¨rnsson et al 3 found no difference in outcomes among patients with surgery performed within 3, 6, or 12 weeks of injury.…”

Section: Discussionmentioning

confidence: 99%

Long-term Results of Arthroscopic Repair of Full-Thickness Traumatic Rotator Cuff Tears in Active Duty Military Patients Under the Age of 40 Years

et al. 2022

View full text Add to dashboard Cite

Background: Arthroscopic rotator cuff repair is an effective procedure through which to decrease pain and increase strength, with favorable long-term outcomes demonstrated in older patient populations with full-thickness rotator cuff tears. The long-term outcomes after this procedure in younger, higher-demand patients, however, is not as clearly defined. Purpose: To report on the long-term outcomes after arthroscopic rotator cuff repair of traumatic full-thickness rotator cuff tears in active duty military patients under the age of 40 years at the time of surgery. Study Design: Case series; Level of evidence, 4. Methods: Preoperative, midterm, and final evaluations were collected, including scores on the visual analog scale for pain, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons shoulder form. A total of 42 patients were screened for inclusion: 3 underwent additional surgical procedures on the operative shoulder and 2 were lost to follow-up, leaving 37 patients with mean follow-up of 104.51 months available for analysis. A subgroup analysis was performed comparing outcomes between patients with Southern California Orthopaedic Institute grade 1 or 2 tears and those with grade 3 or 4 tears. Results: At final follow-up, pain per the visual analog scale decreased to 1.16 from 8.03 ( P < .0001); the Single Assessment Numeric Evaluation score increased to 87.32 from 48.24 ( P < .0001); and the American Shoulder and Elbow Surgeons score increased to 88.68 from 41.00 ( P < .0001). There was no statistically significant difference in outcome scores or range of motion between midterm and final follow-up. Improvement in outcome scores and range of motion at final follow-up did not vary between patients with small and large tears. Of 42 patients, 37 (88.1%) were able to return to full unrestricted active duty and sporting activity, while 5 (11.9%) were medically separated from the military. Conclusion: Active duty military patients under the age of 40 years with traumatic full-thickness rotator cuff tears had statistically and clinically significant increases in outcome scores and decreases in pain after arthroscopic rotator cuff repair at long-term follow-up.

show abstract

“…Kannus and Józsa suggested already 1991 that tendon rupture is closely associated with preceding histopathological changes [ 19 ] which is supported by later studies reporting high prevalence of asymptomatic supraspinatus tears [ 24 , 31 , 33 , 40 , 48 ]. Despite this suggested overall degenerative genesis of rotator cuff tears, trauma-related tears are often studied and discussed as acute injuries and separated from chronic, nontraumatic tears [ 13 , 29 , 34 , 38 , 42 , 50 ]. In trauma-related tears, early surgical repair is often advocated with the argument of superior healing properties and the advancing muscle atrophy and fatty infiltration [ 9 , 13 , 34 , 43 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite this suggested overall degenerative genesis of rotator cuff tears, trauma-related tears are often studied and discussed as acute injuries and separated from chronic, nontraumatic tears [ 13 , 29 , 34 , 38 , 42 , 50 ]. In trauma-related tears, early surgical repair is often advocated with the argument of superior healing properties and the advancing muscle atrophy and fatty infiltration [ 9 , 13 , 34 , 43 ].…”

Section: Introductionmentioning

confidence: 99%

No differences in histopathological degenerative changes found in acute, trauma-related rotator cuff tears compared with chronic, nontraumatic tears

Aagaard

Hallgren

Lunsjö

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose Acute trauma-related rotator cuff tears are believed to have better healing potential than chronic tears due to less degenerative changes of the tendons. However, the histopathological condition of tendons from trauma-related tears is not well investigated. The purpose of this study was to explore specific histopathological features in tendons from acute trauma-related full-thickness rotator cuff tears and to compare them to findings in tendons from nontraumatic, chronic tears. Methods In a prospective cohort study, 62 previously asymptomatic patients [14 women, median age 61 years (range 42–75)] with trauma-related full-thickness rotator cuff tears were consecutively included. Arthroscopic repair was performed within 30 (median, IQR 25–37) days after the injury. During surgery, tissue biopsies were harvested from the supraspinatus tendons in 53 (86%) of the patients. In addition, similar biopsies were harvested from 10 patients undergoing surgery for chronic tears without history of trauma. All tissue samples were examined by a well-experienced pathologist under light microscope. Tendon degeneration was determined using the Bonar score whereas immunostaining was used for proliferation (Ki67), inflammation (CD45), apoptosis (p53) and haemosiderin staining to study traces of bleeding. Results The median (IQR) Bonar score for the acute trauma-related biopsies was 10.5 (7.5–14.5) compared to 11 (5–12.8) for the control group with no statistically significant difference between the groups. No statistically significant between-group difference was found for the inflammatory index whereas tendons from patients with trauma-related full-thickness rotator cuff tears had statistically significantly higher apoptosis [3.1 (0.5–8.9) vs. 0.1 (0–1.5), p = 0.003] and proliferation [4.0 (1.8–6.9) vs. 0.4 (0–2.0), p = 0.001) indices than those undergoing surgery for chronic tears. Positive haemosiderin staining was found in 34% of tissue samples from patients with trauma-related tears compared to 10% in the control group (n.s). Conclusion This study suggests that there is no difference with regard to degenerative changes between supraspinatus tendons harvested from patients with acute, trauma-related rotator cuff tears and patients with nontraumatic, chronic tears. Level of evidence II.

show abstract

Early repair of traumatic rotator cuff tears improves functional outcomes

Cited by 39 publications

References 28 publications

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

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

Long-term Results of Arthroscopic Repair of Full-Thickness Traumatic Rotator Cuff Tears in Active Duty Military Patients Under the Age of 40 Years

No differences in histopathological degenerative changes found in acute, trauma-related rotator cuff tears compared with chronic, nontraumatic tears

Contact Info

Product

Resources

About