Saturday, March 27, 2021

Traumatic rotator cuff tears: "a stitch in time saves nine".

Early repair of traumatic rotator cuff tears improves functional outcomes

Most rotator cuff tears (RCTs) are chronic in nature and occur in tendons that are weakened because of degenerative changes. However,  about 8% of RCTs are acute, resulting from traumatic events.

These authors sought to determine how functional outcomes are affected by surgical timing in traumatic rotator cuff tears (RCTs). They performed a retrospective review on patients having repair of traumatic full thickness RCTs characterized as a full thickness tear attributed to a definite traumatic event.

206 patients (150 males and 56 females) with mean age of 60 years and a minimum of 2 years of clinical follow-up were included in this study.

Patients were divided into 4 groups based on the time from injury to surgery: 0 to 2 months (group 1), 2 to 4 months (group 2), 4 to 6 months (group 3), and 6-12 months (group 4).

The average tear area was 8.4 cm2 for group 1 (66 patients), 5.8  cm2 for group 2 (76 patients), 5.1 cm2 for group 3 (29 patients), and 3.7  cm2 for group 4 (35 patients). It is of note that the earlier (0 to 2 mo) repaired tears were bigger and were more symptomatic (SST of 3).

A multivariate regression demonstrated that patients having surgery within four months of injury resulted in an estimated 1.8 point improvement in the Simple Shoulder Test (SST), a 10.3 point improvement for ASES, 8.6 for SANE, and 0.93 for VAS pain compared to those with surgery later. 

It is of note that larger tears tended to be repaired earlier. In this study, all patients with massive tears (>18cm2) underwent repair within the first 4 months of injury, and all tears 11 cm2 or larger were repaired within 5 months of injury. Interestingly, increased tear size did not result in either inferior functional outcomes or increased symptomatic re-tear rates. 

Based on the finding in this paper, the authors recommend that rotator cuff repair should be performed within 3 weeks of the traumatic event to achieve the best results and within 4 months of injury to prevent significant functional limitations.

In these authors’ experience, the mean time to initial presentation to an orthopedic surgeon was nearly 2 months after the injury. They suggest that it is important for providers (including primary care and emergency room physicians) to obtain MRIs expediently and refer patients promptly to allow for the best outcomes. 

Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).