School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
J Shoulder Elbow Surg. 2022 Jun;31(6S):S18-S24. doi: 10.1016/j.jse.2021.12.028. Epub 2022 Jan 24.
The time from symptom onset to surgery has been shown to impact functional outcomes after repair of traumatic rotator cuff tears (RCTs), but this temporal relationship has not yet been evaluated in patients with atraumatic, degenerative cuff tears. Furthermore, it has been shown that over time, atraumatic cuff tears tend to enlarge and become more symptomatic, retracted, and atrophic-factors that have been shown to decrease success rates after repair. The aim of this study was to evaluate the relationship between the time from symptom onset to surgery and postoperative outcomes in patients with atraumatic RCTs.
We performed a retrospective cohort study of patients with degenerative, atraumatic RCTs who underwent surgery performed by 2 fellowship-trained shoulder surgeons and had at least 12 months of postoperative follow-up. These patients were divided into 2 cohorts based on the duration between symptom onset and surgery: early (<12 months) and delayed (≥12 months). The primary outcome measures included reoperation rate and failure of repair. Secondary outcomes included clinical measures of strength and range of motion and patient-reported outcome measures consisting of the Subjective Shoulder Value, visual analog scale for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment, and Brophy-Marx Activity Scale at last follow-up.
Of the 143 patients who met the inclusion criteria, 78 (54.5%) underwent surgery within 1 year of symptom onset whereas 65 (45.5%) underwent surgery after at least 1 year. There were no differences between groups regarding demographic or tear characteristics. At final follow-up, there were no differences between the early- and late-surgery groups regarding retear rate (12% vs. 9%, P = .65), reoperation rate (5% vs. 3%, P = .54), postoperative range of motion in any plane (P > .05), strength in external rotation and internal rotation, visual analog scale pain score, or Subjective Shoulder Value. A greater proportion of the early group (61%) than the late group (46%) experienced improvement in supraspinatus strength of ≥1 grade on manual muscle testing (P = .02) and post hoc analysis.
Despite our knowledge of the natural history of chronic, atraumatic RCTs, delaying surgical treatment for 1 year or more does not appear to significantly impact postoperative outcomes. Thus, it is reasonable for physicians to recommend either conservative or surgical treatment depending on patient-specific factors and expectations.
症状出现到手术的时间已被证明会影响外伤性肩袖撕裂（RCT）修复后的功能结果，但在非外伤性、退行性肩袖撕裂患者中，这种时间关系尚未得到评估。此外，已经表明，随着时间的推移，非外伤性肩袖撕裂往往会增大并变得更加有症状、回缩和萎缩——这些因素已被证明会降低修复后的成功率。本研究的目的是评估症状出现到手术的时间与非外伤性 RCT 患者术后结果之间的关系。
我们对接受了由 2 位 fellowship培训的肩部外科医生进行的手术且术后有至少 12 个月随访的退行性、非外伤性 RCT 患者进行了回顾性队列研究。这些患者根据症状出现到手术的时间分为 2 个队列：早期（<12 个月）和延迟（≥12 个月）。主要观察指标包括再次手术率和修复失败率。次要观察指标包括力量和运动范围的临床测量以及包括主观肩部值、疼痛视觉模拟评分、美国肩肘外科医生标准肩部评估和 Brophy-Marx 活动量表在内的患者报告结果测量，均在最后随访时进行评估。
在符合纳入标准的 143 名患者中，78 名（54.5%）在症状出现后 1 年内接受了手术，而 65 名（45.5%）在至少 1 年后接受了手术。两组在人口统计学或撕裂特征方面无差异。在最终随访时，早期手术组和晚期手术组在再撕裂率（12% vs. 9%，P=.65）、再次手术率（5% vs. 3%，P=.54）、任何平面的术后运动范围（P>.05）、外旋和内旋力量、视觉模拟评分疼痛量表或主观肩部值方面均无差异。早期组（61%）比晚期组（46%）有更大比例的患者在手动肌肉测试中肩袖上旋力量提高≥1 级（P=.02），且进行了事后分析。
尽管我们了解慢性、非外伤性 RCT 的自然病史，但将手术治疗推迟 1 年或更长时间似乎不会显著影响术后结果。因此，医生根据患者的具体情况和预期，建议进行保守或手术治疗是合理的。
