Rotator cuff tears (RCT) are the most common shoulder disorder treated by an orthopaedic surgeon1. The number of people affected by RCT is highlighted by the fact that 25% of individuals in their 60s and 50% of persons in their 80s are afflicted by full-thickness degenerative RCT1. Due to their high prevalence, a major quandary in orthopedics is whether a patient experiencing a symptomatic degenerative RCT should be managed conservatively initially and if the conservative treatment fails undergo surgical repair or if they should be treated surgically immediately2. Therefore, because of the relatively high variance in management for degenerative RCT paired with the fact that time to presentation from symptom onset and time to surgery from presentation is patient-, physician-, and institution-dependent, this study sought to determine the impact that time from symptom onset to surgery has on clinical and patient-reported outcomes.
A retrospective cohort study of patients with degenerative RCT with at least 12 months of follow-up, but an average of 74±38 months, from surgery were included in this study. The patients of two fellowship-trained shoulder surgeons (n=143) were divided into two cohorts based on duration of time between symptom onset and surgery: early (fewer than 12 months; n=78) and delayed (greater than 12 months; n=65). The primary outcome measures included reoperation rate and failure of repair. Secondary outcomes included the clinical measures of strength and range of motion and the patient-reported outcome measures of Subjective Shoulder Value (SSV), Visual Analog Pain Scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) and Brophy-Marx Activity Scale.
The average symptom duration to surgery was 5.3±2.9 months and 41.1±37.0 months for the early and delayed groups, respectively (p-value <0.0001). The study found no significant difference in age (59±12, 58±11; p-value 0.77), number of females (48, 35; p-value 0.35), number of reoperations (3,2; p-value 0.26), or number of failed repairs (9, 4; p-value 0.57), post-operative SSV (80.8±22.6, 84.9±12.9; p-value 0.32), post-operative ASES (65.0±21, 54.1±23.1; p-value 0.8688), and post-operative VAS (1.9±2.8, 2.4±3.0; p-value 0.3324). The difference between post-operative and pre-operative SSV, ASES and VAS were also found to be non-significant: 28.41±24.80, 28.42±27.69 (p-value 1.00); 34.9±25.6, 9.2±9.2 (p-value 0.10); 4.9±3.0, 4.9±2.9 (p-value 1.00).
Our analysis found that there was no significant difference in any of the above outcomes following surgery indicating that, on average, time from symptom onset to surgical intervention does not adversely affect functionality or quality of life post-operatively. Thus, it is reasonable for physicians to recommend either conservative or surgical treatment upon initial presentation of patients with degenerative RCT.
1. Tashjian, R, Epidemiology, Natural History, and Indications for Treatment of Rotator Cuff Tears, Clinics in Sports Medicine, 2012;31(4):589-604.
2. Itoi E. Rotator cuff tear: physical examination and conservative treatment. J Orthop Sci. 2013;18(2):197-204.