Comparison of outcomes with arthroscopic repair of acute-on-chronic within 6 months and chronic rotator cuff tears

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Background

The purpose of this study was to define preoperative and intraoperative findings of acute-on-chronic rotator cuff tears (RCTs). This study also compared the functional and clinical outcomes with acute-on-chronic RCTs and chronic RCTs.

Methods

This study was conducted between December 2007 and December 2013. An acute-on-chronic full-thickness RCT was diagnosed with preoperative and intraoperative findings on arthroscopy. The study group consisted of 36 patients with preoperative and intraoperative findings (surgery performed within 6 months of trauma) indicative of an acute-on-chronic RCT. Another 36 patients matched for age, sex, and tear size, who underwent arthroscopic rotator cuff repair after 6 months of onset of symptoms (chronic RCT group), were selected from our institution's database within the same time frame. Postoperative indirect magnetic resonance arthrogram was obtained 6 months after the repair, and rotator cuff integrity was graded according to the guidelines as described by Sugaya. Patients were evaluated using the visual analog scale for pain, American Shoulder and Elbow Surgeons Shoulder Assessment score, and Constant scores. Scores and measurements were obtained preoperatively and at 6, 12, and 24 months after surgery.

Results

The clinical outcomes and range of motion recovery were better in the acute-on-chronic RCT group. Although statistically not significant, the acute-on-chronic RCT group's repair appeared closer to the complete repair and was associated with a lesser incidence of retear than the chronic RCT group.

Conclusion

Early repair of an acute-on-chronic full-thickness RCT results in a statistically and clinically superior improvement in outcomes compared with repairs of chronic RCTs.

Section snippets

Materials and methods

This study was a retrospective case-control study of prospectively collected data of patients confirmed as having acute-on-chronic RCTs. Between December 2007 and December 2013, 1280 rotator cuff repairs were performed by a single senior surgeon (J.C.Y.) in our institution. Acute-on-chronic RCTs were defined by 2 major criteria: (I) preoperative findings, and (II) arthroscopic intraoperative findings (Table I).

The preoperative findings of acute-on-chronic RCTs were (i) definite history of

Acute-on-chronic RCT group

In the acute-on-chronic RCT group, the mean time from injury to surgery was 84.4 days (range, 19-172 days). The 2-year follow-up rate was 97% (35 of 36; Table II). Postoperative complications occurred in 2 patients. An infection developed 2 months postoperatively in 1 patient and required arthroscopic surgery. A retear in the second patient required revision arthroscopic rotator cuff repair.

Chronic RCT group

In the chronic RCT group, the mean time from injury to surgery was 25.7 months (range, 6-120 months). The

Discussion

This study demonstrates that acute-on-chronic RCTs repaired within 6 months of injury resulted in better clinical outcomes during a 2-year follow-up period compared with chronic tears. This result is consistent with other studies that demonstrated better outcomes with repairs in traumatic RCTs than in degenerative RCT.3, 9 Our study clearly demonstrates that there is a subgroup of chronic RCTs that has an acute component, which, if recognized and treated early, is associated with better

Conclusions

Early repair (within 6 months) of acute-on-chronic full-thickness RCTs resulted in a statistically and clinically superior improvement in outcomes compared with repairs of chronic RCTs. They also had lower retear rates and a higher potential of being restored to their original footprint coverage.

We propose that a distinct subgroup of RCTs be recognized as acute-on-chronic RCTs. In this study, we suggest criteria to define this subgroup. Early intervention in this group resulted in better

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (17)

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The Institutional Review Board at the Sungkyunkwan University College of Medicine, Samsung Medical Center approved this study (No. 2016-02-002).

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