Delayed arthroscopic repair in massive traumatic rotator cuff tears: is it worth repairing?

PURPOSE

The aim of this study was to analyze the functional and radiological outcomes of delay arthroscopic repair of traumatic massive rotator cuff tears (mRCTs).

METHODS

This is a prospective study of patients with traumatic mRCTs treated by arthroscopic repair within the first 12 months after trauma. Degenerative tears, single tendon tears, associated fractures, severe arthropathy, irreparable tears, patients older than 75, and those with less than 1 year of follow-up were excluded. Range of motion, pain, and the ASES score were analyzed. MRI was performed preoperatively to assess the rotator cuff tear and 6 months after surgery to evaluate tendon healing. The average follow-up was 22 (± 6.3) months. A p value of < 0.05 was considered statistically significant.

RESULTS

A total of 20 patients were included, with a mean age of 61.7 (± 8) years, 60% male, 65% dominant side affected, and 65% manual workers. The mean time to diagnosis was 4.5 (± 2.7) months, and the mean time to surgery was 7.6 (± 3) months. The mean ASES score was 80.6 ± 15 95% of patients achieved satisfactory results. Elevation improved by a mean difference of - 38 degrees (p < 0.001), external rotation - 29 degrees (p < 0.001), pain decreased by 6 points (p < 0.001), and the ASES score improved by 41 points (p < 0.001). The rate of retear was 60% and patients in whom surgery was performed more than 6 months after the trauma had a 4.7-fold increased risk of retear (p = 0.018). Patients without a retear demonstrated better postoperative external rotation (p = 0.013) and ASES scores (p = 0.033).

CONCLUSIONS

Delayed arthroscopic repair of massive traumatic rotator cuff tears led to good functional outcomes in 95% of patients, despite a rate of retear of 60%. Patients operated on more than 6 months after trauma had a relative risk of 4.7 for presenting a retear.