Baur Alexander, Lemons Wesley, Protzuk Omar, Goodloe Jonathan Brett
Department of Research, Liberty University College of Osteopathic Medicine, 306 Liberty View Ln, Lynchburg, VA 24502, USA.
Department of Orthopaedics, Virginia Commonwealth University School of Medicine, 1201 E Marshall St. #4-100, Richmond, VA 23298, USA.
J Clin Med. 2025 Aug 6;14(15):5552. doi: 10.3390/jcm14155552.
Optimal timing for surgery following acute rotator cuff tears remains unclear. This study examines how the timing of arthroscopic rotator cuff repair (RCR) affects retear rates and functional outcomes. This PROSPERO-registered review (CRD42024528249) followed PRISMA guidelines and included randomized trials, and cohort, studies on adults with imaging-confirmed full-thickness rotator cuff tears. Studies lacking timing data or key outcomes were excluded. Risk of bias was assessed using ROBINS-I. Meta-analysis of retear rates was performed comparing surgical timing. Qualitative analysis was conducted classifying results as early-beneficial, delayed-detrimental, or neutral. Our review included 13 studies and 871 patients with an average age of 57.9. Meta-analysis of eight studies comparing retear rates between early and delayed RCR demonstrated a significant benefit associated with early intervention risk ratio 0.60 (95% CI: 0.38-0.96). Functional outcomes also favored early intervention with four studies demonstrating significantly greater postoperative functional improvements in the early intervention group. Early arthroscopic RCR decreased the rate of retear and improved functional outcomes. No study found early intervention to be detrimental or delayed intervention to be superior. These findings support consideration of early repair when clinically appropriate. Future studies should determine more finite timing guidelines.
急性肩袖撕裂后手术的最佳时机仍不明确。本研究探讨关节镜下肩袖修复（RCR）的时机如何影响再撕裂率和功能结局。这项在PROSPERO注册的综述（CRD42024528249）遵循PRISMA指南，纳入了随机试验以及针对影像学确诊为全层肩袖撕裂的成年人的队列研究。缺乏时间数据或关键结局的研究被排除。使用ROBINS - I评估偏倚风险。对再撕裂率进行荟萃分析以比较手术时机。进行定性分析，将结果分类为早期有益、延迟有害或中性。我们的综述纳入了13项研究和871例患者，平均年龄为57.9岁。对八项比较早期和延迟RCR再撕裂率的研究进行的荟萃分析表明，早期干预有显著益处，风险比为0.60（95%CI：0.38 - 0.96）。功能结局也支持早期干预，四项研究表明早期干预组术后功能改善明显更大。早期关节镜下RCR降低了再撕裂率并改善了功能结局。没有研究发现早期干预有害或延迟干预更优。这些发现支持在临床合适时考虑早期修复。未来的研究应确定更确切的时间指南。
