Comparison of outcomes with arthroscopic repair of acute-on-chronic within 6 months and chronic rotator cuff tears
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.
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Factors associated with healing failure after early repair of acute, trauma-related rotator cuff tears
2023, Journal of Shoulder and Elbow SurgeryEarly postoperative recovery comparisons of superior capsule reconstruction to tendon transfers
2023, Journal of Shoulder and Elbow SurgeryCitation Excerpt :Primary repair is controversial, given failure rates can reach 94%.21 There are multiple factors that predict failure of primary repairs, leading the tears to be classified as “irreparable,” including the failed prior rotator cuff repair, muscular fatty infiltration,25,28,31,40,62 tendon retraction,35 tendon length,40 and chronicity.15,21,31,35,49 If deemed functionally irreparable, the treatment options include arthroscopic débridement,39,61 partial repair,4,9,14,36,54 augmentation or bridging with allografts,3,10,20,37,47,55 SCR,2,13,42,48,65 subacromial balloon,50 or shoulder TTs.8,12,16-19,22-24,26,27,33,34,46,57,60,63,64
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2022, Journal of Shoulder and Elbow SurgeryGreater Tuberosity Bone Mineral Density and Rotator Cuff Tear Size Are Independent Factors Associated With Cutting-Through in Arthroscopic Suture-Bridge Rotator Cuff Repair
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryOutcome of arthroscopically assisted lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tears
2020, Journal of Shoulder and Elbow SurgeryCitation Excerpt :Surgically managing massive irreparable posterosuperior rotator cuff tears is controversial. A number of factors may contribute to tear irreparability, including muscular fatty infiltration,16,19,25,32,42 tendon retraction,29 and chronicity.4,12,25,29,37 In the absence of advanced arthritis, joint-preserving treatment options include arthroscopic débridement,30,41 partial repair,1,38 patch or interposition grafting,31,36 superior capsular reconstruction,33 and tendon transfers including the latissimus dorsi2,14,17,18,28,43 and LTT.9,10
The Institutional Review Board at the Sungkyunkwan University College of Medicine, Samsung Medical Center approved this study (No. 2016-02-002).