Time to surgery in acute rotator cuff tear

Abstract

AimsWe performed a systematic review of the literature to determine whether earlier surgical repair of acute rotator cuff tear (ARCT) leads to superior post-operative clinical outcomes.MethodsThe MEDLINE, Embase, CINAHL, Web of Science, Cochrane Libraries, controlled-trials.com and clinicaltrials.gov databases were searched using the terms: ‘rotator cuff’, or ‘supraspinatus’, or ‘infraspinatus’, or ‘teres minor’, or ‘subscapularis’ AND ‘surgery’ or ‘repair’. This gave a total of 15 833 articles. After deletion of duplicates and the review of abstracts and full texts by two independent assessors, 15 studies reporting time to surgery for ARCT repair were included. Studies were grouped based on time to surgery < 3 months (group A, seven studies), or > 3 months (group B, eight studies). Weighted means were calculated and compared using Student’s t-test. ResultsGroup B had a significantly higher pre-operative Constant score (CS) (p < 0.001), range of movement in external rotation (p = 0.003) and abduction (p < 0.001) compared with group A. Both groups showed clinical improvement with surgical repair; group A had a significantly improved Constant score, University of California, Los Angeles (UCLA) shoulder score, abduction and elevation post-operatively (all p < 0.001). Group B had significantly improved Constant score (p < 0.001) and external rotation (p < 0.001) post-operatively. The mean Constant score improved by 33.5 for group A and by 27.5 for group B.ConclusionThese findings should be interpreted with caution due to limitations and bias inherent to case-series. We suggest a trend that earlier time to surgery may be linked to better Constant score, and active range of movement in abduction and elevation. Additional prospective studies are required.

Elasticity of torn supraspinatus tendons measured by shear wave elastography: a potential surrogate marker of chronicity?

“…Therefore, it is necessary to determine whether a patient is suffering from an acute or chronic rotator cuff tear prior to surgical intervention. However, it is challenging to distinguish among acute tears, acute-on-chronic tears, and chronic tears with acute symptoms, both on clinical grounds and using imaging modalities such as radiography, dynamic sonography, MRI, and arthroscopy [16].…”

Time-sensitive ambulatory orthopaedic soft-tissue surgery paradigms during the COVID-19 pandemic

“…The delay in repair was also associated with decreasing greater tuberosity bone density, which may contribute to poor healing [12]. A systematic review by Mukovozov et al showed a trend suggesting that surgeries performed within three months of an acute rotator cuff tear were linked to better post-operative range of motion and Constant scores [13]. The authors did conclude that their findings should be interpreted with caution due to the limitations and bias inherent in case series as 11 of the 15 studies were retrospective, and there was not randomized controlled trials available for analysis.…”

Rotator cuff tears: is non-surgical management effective?

“…28 A recent systematic review found a minimal difference in favour of the early surgery group (<3 months) but due to limitations and bias within the studies the results should be viewed with caution. 31 The authors also did not include non-surgical outcomes within their study. It has previously been reported that duration of symptoms is not related to the degree of muscle weakness, limited range of motion, tear size, fatty atrophy or validated patient reported outcome measures.…”