Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon

Cornelia Baum^{1

2}, Laurent Audigé^{3

2}, Thomas Stojanov^{4

2}, Sebastian A Müller^{5

2}, Christian Candrian^{6

2}; ARCR_Pred Study Group²; Andreas M Müller^{1

2}, Claudio Rosso^{7

2}, Lena Fankhauser², Gernot Willscheid^{8

2}, Philipp Moroder², Doruk Akgün², Victor Danzinger², Henry Gebauer², Jan-Philipp Imiolczyk², Katrin Karpinski², Lucca Lacheta², Marvin Minkus², Alp Paksoy², Eduardo Samaniego², Kathi Thiele², Isabella Weiss^{9

2}, Thomas Suter², Julia Müller-Lebschi², Sebastian Mueller², Markus Saner², Claudia Haag-Schumacher², Giorgio Tamborrini-Schütz^{10

2}, Mai Lan Dao Trong², Carlos Buitrago-Tellez², Julian Hasler², Ulf Riede², Sandra Weber^{11

2}, Beat Moor², Matthias Biner², Sarah Fournier², Nicolas Gallusser², Deborah Marietan², Sebastien Pawlak^{12

2}, Christoph Spormann², Britta Hansen², Nadja Mamisch^{13

2}, Holger Durchholz², Jakob Bräm^{14

2}, Gregory Cunningham², Abed Kourhani², Sarah Ossipow², Patricia Simao^{15

2}, Alexandre Lädermann^{16

2}, Rainer Egli², Stephanie Erdbrink², Remy Flückiger², Paolo Lombardo², Tawan Pinworasarn², Philipp Scacchi², Johannes Weihs², Matthias Zumstein^{17

2}, Matthias Flury², Ralph Berther², Christine Ehrmann², Larissa Hübscher^{18

2}, David Schwappach^{19

2}, Karim Eid², Susanne Bensler², Yannick Fritz², Nisha Grünberger², Philipp Kriechling², Daniel Langthaler², Richard Niehaus², Raffaela Nobs^{20

2}, Emanuel Benninger², Quintin de Groot², Aleksis Doert², Sebastian Ebert², Philemon Grimm², Fabian Mottier², Markus Pisan², Jan Schätz², Ariane Schwank², Julian Wiedenbach^{21

2}, Markus Scheibel², Laurent Audigé², Frederik Bellmann², Daniela Brune², Marije de Jong², Stefan Diermayr², David Endell², Marco Etter², Florian Freislederer², Nikitas Gkikopoulos², Michael Glanzmann², Cécile Grobet², Christian Jung², Fabrizio Moro², Philipp Moroder², Ralph Ringer², Jan Schätz², Hans-Kaspar Schwyzer², Béatrice Weber², Martina Wehrli², Barbara Wirth², Manuela Nötzli², Anne Franz², Jörg Oswald², Birgit Steiger², Yacine Ameziane², Christopher Child², Giovanni Spagna^{22

2}, Christian Candrian², Filippo Del Grande², Pietro Feltri², Giuseppe Filardo², Francesco Marbach², Florian Schönweger^{23

2}, Bernhard Jost², Michael Badulescu², Stephanie Lüscher², Fabian Napieralski², Lena Öhrström², Martin Olach², Jan Rechsteiner², Jörg Scheler², Christian Spross², Vilijam Zdravkovic^{24

2}, Matthias A Zumstein², Adrian Chlasta², Kate Gerber², Annabel Hayoz², Julia Müller-Lebschi², Frederick Schuster^{25

2}, Karl Wieser², Paul Borbas², Samy Bouaicha², Roland Camenzind², Sabrina Catanzaro², Christian Gerber², Florian Grubhofer², Anita Hasler², Bettina Hochreiter², Roy Marcus², Farah Selman², Reto Sutter², Sabine Wyss^{26

2}, Christian Appenzeller-Herzog^{27

2}, Soheila Aghlmandi², Ilona Ahlborn², Cornelia Baum², Franziska Eckers², Kushtrim Grezda², Simone Hatz², Sabina Hunziker², Thomas Stojanov², Mohy Taha², Giorgio Tamborrini-Schütz², Andreas Marc Mueller²

Affiliations

¹ Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.
² Investigation performed at University Hospital Basel, Basel and the Schulthess Klinik, Zurich, Switzerland.
³ Surgical Outcome Research Center, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland.
⁴ Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland.
⁵ Department of Orthopaedic and Trauma Surgery, Shoulder and Elbow, Cantonal Hospital Baselland, Bruderholz, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
⁶ Trauma and Ortho Unit, Ospedale Regionale di Lugano, Lugano, Switzerland.
⁷ Principal Investigator [PI]).
⁸ Charitè Medicine University, Berlin, DE.
⁹ Cantonal Hospital Baselland, Bruderholz, CH.
¹⁰ Public Hospital Solothurn, Solothurn, CH.
¹¹ Hôpital du Valais-Centre Hospitalier du Valais Romand, Martigny, CH.
¹² Endoclinic, Zurich, CH.
¹³ Klinik Gut, St Moritz, CH.
¹⁴ Hirslanden Clinique la Colline, Geneva, CH.
¹⁵ La Tour Hospital, Meyrin, CH.
¹⁶ Inselspital, Bern, CH.
¹⁷ In-Motion, Wallisellen, CH.
¹⁸ Institute of Social and Preventive Medicine, University of Bern, Bern, CH.
¹⁹ Cantonal Hospital of Baden, Baden, CH.
²⁰ Cantonal Hospital of Winterthur, Winterthur, CH.
²¹ Schulthess Klinik, Zurich, CH.
²² Ospedale Regionale di Lugano, Lugano, CH.
²³ Cantonal Hospital of St. Gallen, St. Gallen, CH.
²⁴ Orthopädie Sonnenhof, Bern, CH.
²⁵ University Clinic Balgrist, Zurich, CH.
²⁶ University Library Basel, University of Basel, Basel, CH.
²⁷ University Hospital of Basel, Basel, CH.

PMID: 38259113
PMCID: PMC10838469
DOI: 10.1177/03635465231219253

Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon

Cornelia Baum et al. Am J Sports Med. 2024 Feb.

. 2024 Feb;52(2):441-450.

doi: 10.1177/03635465231219253. Epub 2024 Jan 23.

Authors

Affiliations

¹ Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.
² Investigation performed at University Hospital Basel, Basel and the Schulthess Klinik, Zurich, Switzerland.
³ Surgical Outcome Research Center, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland.
⁴ Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland; Research and Development, Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland.
⁵ Department of Orthopaedic and Trauma Surgery, Shoulder and Elbow, Cantonal Hospital Baselland, Bruderholz, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
⁶ Trauma and Ortho Unit, Ospedale Regionale di Lugano, Lugano, Switzerland.
⁷ Principal Investigator [PI]).
⁸ Charitè Medicine University, Berlin, DE.
⁹ Cantonal Hospital Baselland, Bruderholz, CH.
¹⁰ Public Hospital Solothurn, Solothurn, CH.
¹¹ Hôpital du Valais-Centre Hospitalier du Valais Romand, Martigny, CH.
¹² Endoclinic, Zurich, CH.
¹³ Klinik Gut, St Moritz, CH.
¹⁴ Hirslanden Clinique la Colline, Geneva, CH.
¹⁵ La Tour Hospital, Meyrin, CH.
¹⁶ Inselspital, Bern, CH.
¹⁷ In-Motion, Wallisellen, CH.
¹⁸ Institute of Social and Preventive Medicine, University of Bern, Bern, CH.
¹⁹ Cantonal Hospital of Baden, Baden, CH.
²⁰ Cantonal Hospital of Winterthur, Winterthur, CH.
²¹ Schulthess Klinik, Zurich, CH.
²² Ospedale Regionale di Lugano, Lugano, CH.
²³ Cantonal Hospital of St. Gallen, St. Gallen, CH.
²⁴ Orthopädie Sonnenhof, Bern, CH.
²⁵ University Clinic Balgrist, Zurich, CH.
²⁶ University Library Basel, University of Basel, Basel, CH.
²⁷ University Hospital of Basel, Basel, CH.

PMID: 38259113
PMCID: PMC10838469
DOI: 10.1177/03635465231219253

Abstract

Background: Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial.

Purpose: To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears.

Study design: Cohort study; Level of evidence, 2.

Methods: Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects.

Results: From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups.

Conclusion: Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.

Keywords: degenerative rotator cuff tear; rotator cuff repair; shoulder arthroscopy; shoulder surgery outcome; traumatic rotator cuff tear.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This project was funded by the Swiss National Science Foundation (SNF Project ID 320030_184959, http://p3.snf.ch/project-184959). Complementary grants were provided by Swiss Orthopedics to support project site documentation. The following sites are funding their participation in the project: Charitè Medicine University, Berlin, Germany; Public Hospital Solothurn, Solothurn, Switzerland; Endoclinic, Zurich, Switzerland; Inselspital, Bern, Switzerland; and University Clinic Balgrist, Zurich, Switzerland. C.B. received funding for her research salary from the University Hospital Basel, Department of Surgery. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

**Figure 1.**
Patient selection flowchart highlighting follow-up rates at 6, 12, and 24 months after ARCR. ARCR, arthroscopic rotator cuff repair; SSP, supraspinatus.

**Figure 2.**
Comparison of (A) abduction, (B) flexion, (C) internal rotation at 90° of abduction, and (D) external rotation at 0° of abduction at the baseline, 6, and 12 months of follow-up for patients with degenerative and traumatic tears. Means and SEMs are presented, where * indicates statistically significant differences between groups.

**Figure 3.**
(A) The Constant-Murley Score, (B) the pain level on the Numeric Rating Scale (NRS), (C) abduction strength at 90° of abduction, (D) the Subjective Shoulder Value, (E) the EQ5D5L utility index, and (F) the Oxford Shoulder Score for the degenerative and traumatic groups at 6-, 12-, and 24-month follow-ups. Means and SEMs are presented, where * indicates statistically significant differences.

See this image and copyright information in PMC

References

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Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon

Affiliations

Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous