Summary

In cases of acute traumatic rotator cuff tears, a larger amount of retraction in preoperative MRI is associated with larger anteroposterior tear sizes, a greater number of tendons injured, more severe supraspinatus fatty infiltration, and tendon stump delamination and higher values may predict less postoperative pain relief and a smaller improvement in external rotation following surgery.

Abstract

Introduction

In acute traumatic rotator cuff tears, the musculotendinous unit retains its elasticity. The amount of tendon retraction often differs from degenerative tears. The purpose of this study was to examine the correlation between patient demographics and tear characteristics on tendon retraction and postoperative outcomes following repairs of acute, traumatic rotator cuff tears.

Method

40 consecutive patients with full-thickness acute traumatic rotator cuff tears documented on MRI who had at least 1-year postoperative follow-up were identified. Demographic information and time from trauma to the MRI and arthroscopic repair was recorded. The preoperative MRI was examined for tear and anatomic characteristics. Postoperative outcomes were also collected including active range of motion (AROM), American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale (VAS), and Subjective Shoulder Value (SSV).

Results

The mean age of the patients was 63.3 ± 12.4, and the mean time from injury to the MRI evaluation and to repair was 2.5 ± 2.5 and 4.5 ± 5.8 months, respectively. Increased supraspinatus Goutallier fatty infiltration (p = 0.0035), a greater number of torn tendons (p < 0.001), higher levels of delamination (p = 0.0018), and increased anteroposterior tear size (p < 0.001) were associated with more severe tendon retraction. Greater preoperative retraction predicted worse postoperative outcomes regarding VAS (OR: 0.94, 95% CI: 0.89-0.99, p = 0.012) and external rotation (OR: 0.74, 95% CI: 0.55-0.98, p = 0.033). There was no statistical association between the postoperative outcomes and time of injury to surgery (p=0.36). Retear was also not affected by the extent of retraction (p=0.81).

Conclusion

In cases of acute traumatic rotator cuff tears, severity of tendon retraction is associated with larger anteroposterior tear sizes, a greater number of tendons injured, more severe supraspinatus fatty infiltration, and higher degrees of delamination. While the time from injury to MRI did not influence the amount of tendon retraction, increased preoperative retraction may predict less postoperative pain relief and a smaller improvement in external rotation following surgery.