Summary

Patients with traumatic rotator cuff tears experience greater improvements in range-of-motion, strength, and perceived shoulder function than those with degenerative/atraumatic tears.

Abstract

Background

Rotator cuff tears are a common cause of shoulder pain and dysfunction. These injuries may occur due to a traumatic event that causes acute tearing of the rotator cuff tendons. Often, however, these injuries occur secondary to chronic tendon degeneration and subsequent atraumatic tearing. The aim of this study was to examine if repairs of traumatic rotator cuff tears differ in functional and clinical outcomes than their atraumatic counterparts.

Methods

A consecutive series of 221 patients from a single institution was reviewed. All patients underwent arthroscopic rotator cuff repair by a fellowship-trained orthopaedic surgeon. Patients were queried at their initial presentation as to the nature of onset of symptoms. Demographic data and rotator cuff tear characteristics were obtained via chart review. Shoulder range-of-motion and strength, and standard shoulder physical exam findings were recorded both preoperatively and postoperatively at fiinal follow-up. Outcome measures including visual acuity scale pain score (VAS), subjective shoulder value (SSV), Patient-Reported Outcomes Measurement Information System (PROMIS) scores (both mental and physical components), and American Shoulder and Elbow Surgeons Scores (ASES) were collected both pre- and postoperatively.

Results

Of the 221 patients, 73 had traumatic tears and 148 had atraumatic/degenerative tears. There were no differences in patients’ age, body-mass-index, or Charlson comorbidity index between groups. More patients in the traumatic cohort were male (63.0% vs 41.2%, p<0.05) and involved their non-dominant shoulder (61.6% vs 44.6%, p<0.05). Patients in the atraumatic cohort had significantly longer duration of symptoms prior to presentation (17.9 months vs 6.5 months, p<0.05). Preoperatively, the traumatic cohort had less motion to forward elevation (138.0° vs 151.7°, p<0.05), however there were no differences in outcome scores. There were no differences in tendons repaired or Goutallier classification, but the traumatic group had longer operative times (105.9min vs 85.7min, p<0.05). Postoperatively, both groups experienced significant improvements in VAS and SSV scores (p<0.05). However, only the traumatic cohort demonstrated improvements in ASES and the physical PROMIS scores. When comparing cohorts postoperatively, patients with traumatic rotator cuff repairs had greater improvements in SSV (40.6% vs 29.2%, p<0.05), greater improvement to forward elevation (21.6° vs 2.3°, p<0.05), and gained more strength to forward elevation, external rotation, and internal rotation (p<0.05). There were no differences in improvements between cohorts in PROMIS scores or ASES scores.

Conclusion

This study demonstrates that patients with traumatic rotator cuff tears experience greater improvements in range-of-motion, strength, and perceived shoulder function than those with degenerative/atraumatic tears. The findings of this study can be used to educate patients of the improved outcomes following arthroscopic repair of traumatic rotator cuff tears.