Shoulder
The timing of rotator cuff repair for the restoration of function

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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.

Section snippets

Materials and methods

Institutional review board approval was not obtained for this study, as it was not a requirement at our institution at the time that the data were collected. All of the patients returned to the office on their own accord, after a thorough explanation of the study, to be examined.

All patients were prospectively evaluated, with the patient data analysis performed retrospectively. Only those patients who sustained an acute, traumatic, full thickness tear of the rotator cuff, which resulted in the

Results

There were 22 males and 14 females included in this study. Six patients were smokers. The injury was work associated in 12 patients. Twenty-nine patients sustained the injury to their dominant shoulder. Fourteen patients had undergone some form of physical therapy prior to initial presentation, and 9 patients had received an intra-articular cortisone injection prior to presentation. The mean age at time of surgery was 57 years (range, 21–74). The mean time from injury to the first office visit

Discussion

Regardless of the timing of surgery or the size of the rotator cuff tear, surgical repair was successful in reducing pain in our series of patients, consistent with other studies that have investigated rotator cuff repairs.1, 2, 3, 5, 8, 11, 13, 15, 16, 17, 19, 20, 22, 23, 25, 26, 32, 36, 37, 39 Functional improvement was evidenced in all study patients that had a rotator cuff repair within 4 months following injury.

There is support in the literature for the nonoperative management of rotator

Conclusion

In conclusion, the operative repair of an acute, traumatic rotator cuff tear with associated weakness function is predictably improved if the repair occurs within 4 months after injury. Massive rotator cuff tears have poorer functional outcome than smaller tears; however, significant pain relief can be attained with operative repair regardless of the size of the tear. The extent of preoperative fat infiltration did not appreciably affect the functional outcome of our patients following repair.

Disclaimer

The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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    Institutional review board approval was not obtained for this study, as it was not a requirement, at our institution, at the time that the data was collected. All of the patients returned to the office on their own accord, after a thorough explanation of the study, to be examined.

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