Early Repair Improves Clinical Outcome and Healing of Rotator Cuff Tears
Authors: Anshu Singh, Ben Sanofsky, Jon J.P. Warner, Laurence D Higgins
References: Presented at ICSES 2010
Hypothesis: We hypothesize that timing is an independent determinant of the success of rotator cuff repair (RCR). In our blinded case-control study, we use patient-centered metrics, clinical outcome, validated instruments, and ultrasound assessment of repair integrity.
Methods: All RCR performed by the senior author between 2005 and 2007 were screened. Repair within 6 weeks of injury comprised the study group. Charts and imaging were reviewed for age, sex, Goutallier score, tear configuration, smoking, legal claim and diabetes history. These factors were entered into a prospective clinical database by a blinded physician. A control group of patients with greater than 4 months of symptoms prior to RCR was matched on a case by case basis. All 44 individuals were contacted for physical examination, questionnaire, videotaping, and ultrasound by a trained musculoskeletal ultrasonographer blinded to the study. 18 patients in each group completed the study. Two-tailed t-test was used for statistical analysis.
Results: Preoperative patient and tear-related factors were not statistically different between groups. The acute group had a trend towards less active external rotation and more retracted tendon tears. At final follow-up (average 25 months), VAS pain was 2.1 in the delayed group, and 0.33 in the acute group (p=0.02). Subjective shoulder value 75 in the delayed group and 91.2 in the acutely repaired cases (p=0.04). In terms of objective outcome measures, early RCR restored significantly more abduction strength and resulted in significantly higher ASES and Constant scores. Assessment of rotator integrity with dynamic ultrasound revealed that 11% of acute repairs had partial or complete re-tear, compared to 44% of the delayed repairs (p=0.02).
Conclusions: Early RCR results in statistically superior outcomes at 25 months in objective clinical instruments, abduction strength, ultrasound imaging and patient satisfaction. Given these data, surgeons and patients should consider early repair of rotator cuff tears.