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. 2022 Jan;6(1):79-83.
doi: 10.1016/j.jseint.2021.09.003. Epub 2021 Oct 22.

COVID-19-related rotator cuff repair delay

Karch M Smith  1 , J Cade Wheelwright  1 , Garrett V Christensen  2 , Hiroaki Ishikawa  1 , Robert Z Tashjian  1 , Peter N Chalmers  1
Affiliations

COVID-19-related rotator cuff repair delay

Karch M Smith et al. JSES Int. 2022 Jan.

Abstract

Background: Although nonoperative treatment is effective for degenerative rotator cuff tears (RCTs), it remains unclear whether the delay created by a trial of nonoperative treatment negatively influences the outcome of a subsequent surgical repair. In March 2020, the COVID-19 pandemic resulted in an involuntary delay in the surgical treatment of rotator cuff disease, creating a natural experiment. The purpose of this study was to evaluate the outcomes and healing of patients who underwent delayed surgical treatment of chronic degenerative RCTs as compared with the nondelayed surgical treatment of RCTs.

Methods: This was a prospective study of two groups: patients planned to undergo arthroscopic rotator cuff repair between March 16, 2020 and May 1, 2020-the end of the ban on elective surgery-and patients who underwent rotator cuff repair starting six weeks after the ban on elective surgery had been lifted. Preoperatively and at six months postoperatively, we collected the Simple Shoulder Test, the American Shoulder and Elbow Surgeons (ASES) score, and the visual analog scale for pain. We also obtained magnetic resonance imaging (MRI) at six months postoperatively. A power analysis was conducted, and assuming a mean ± standard deviation ASES score of 93.1 ± 13.9 points and a minimum clinically important difference in the ASES score of 27.1 points, 7 patients per group (14 patients in total) would be necessary to have 90% chance of finding a difference.

Results: We included 15 patients within each group and obtained 100% follow-up at six months. In the delay group, the mean ± standard deviation delay was 63 ± 24 days. There were no significant preoperative differences between groups in demographics or tear characteristics. Intraoperatively, there were no differences between groups in repair characteristics. Using a repeated-measures analysis of variance, there were significant preoperative vs. postoperative differences in ASES scores (P < .001), visual analog scale scores (P < .001), and Simple Shoulder Test scores (P < .001), but no differences between groups (P = .910, .519, and 0.852, respectively). On MRI, within the delay group, 58% had healed, whereas within the control group, 85% had healed (P = .202).

Conclusion: COVID-19 caused a two-month delay in the operative treatment of RCTs. This delay did not significantly alter patient-reported outcomes. This delay resulted in a 27% difference in MRI healing rates, which was not statistically significant in this small study. Larger studies should be conducted as our results suggest that a delay in treatment may negatively impact healing rates.

Keywords: COVID-19; Delay; Rotator cuff repair; Rotator cuff tear.

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Figures

Figure 1
Figure 1
Timeline demonstrating the inclusion and exclusion criteria for selecting our arthroscopic rotator cuff delayed vs. nondelayed groups.
Figure 2
Figure 2
These are two T-2 weighted, coronal magnetic resonance imaging (MRI) snapshots of two of our surgical rotator cuff repair patients 6 months after surgery. (A) This image shows evidence of a fluid-filled gap, and thus, this patient’s repair was considered failed. (B) This image shows no evidence of a fluid-filled gap, and this patient’s repair was considered healed.
See this image and copyright information in PMC

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