The timing of rotator cuff repair for the restoration of function

• Published in: Journal of shoulder and elbow surgery Vol. 20; no. 1; pp. 62 - 68
• Main Authors: Petersen, Steve A., MD, Murphy, Todd P., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 2011; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Diseases of the osteoarticular system; Female; function; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; open repair; Orthopedics; Range of Motion, Articular; Rotator Cuff - pathology; Rotator Cuff - surgery; Rotator Cuff Injuries; Rotator cuff repair; Shoulder Joint - physiopathology; Shoulder Pain - etiology; Time Factors; timing; Treatment Outcome; Young Adult; Treatment Study; Retrospective Case Control Study; timing; function; open repair; Level III; Rotator cuff repair; Timing; Restoration; Repair; Rotator cuff; Rheumatology
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2010.04.045

Introduction This study was developed to test the hypothesis that there is a period in which a painful, traumatic rotator cuff tear, with associated weakness and the inability to abduct above shoulder level, should be repaired to allow for improvement in function. Methods Forty-two consecutive, prospectively followed patients met the criteria for entrance into this study. Of those, 36 patients were available for a minimum 9 months follow-up (average, 31 months; range, 9–71) by office visit. Patient outcomes were measured using the UCLA End-Result and ASES scoring systems. Patient variables, including time from injury to repair, tear size, degree of preoperative fat infiltration, patient satisfaction, and improvement in pain, were evaluated for their association with surgical outcome using independent t testing. Time to repair was evaluated at 0–2 months, 2–4 months, and greater than 4 months. Results Pain scores improved from 7 to 1.4 ( P < .01) and active elevation improved from 55° to 133° ( P  < .01). UCLA/ASES scores improved from 8/30 to 26/79, respectively ( P < .01, P < .01). All but 2 of the 36 patients were satisfied with their result. Preoperative fatty atrophy did not correlate with postoperative function. Rotator cuff tear size had no influence on patient outcome if repaired before 4 months. Massive tears repaired after 4 months had the worst outcome. Conclusion Our results emphasize that the treatment outcome for traumatic rotator cuff tears of all sizes, with associated weakness, is not compromised up to 4 months after their injury.