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. 2024 Feb 13;6(2):100867.
doi: 10.1016/j.asmr.2023.100867. eCollection 2024 Apr.

Traumatic and Atraumatic Rotator Cuff Tears Have the Same Rates of Healing

Alberto Guevara-Alvarez  1 , Edwin A Valencia-Ramon  1 , Hugo Bothorel  2 , Philippe Collin  3 , Jeanni Zbinden  4 , Alberto Guizzi  5 , Alexandre Lädermann  4   6   7
Affiliations

Traumatic and Atraumatic Rotator Cuff Tears Have the Same Rates of Healing

Alberto Guevara-Alvarez et al. Arthrosc Sports Med Rehabil. .

Abstract

Background: To examine whether traumatic rotator cuff repairs (RCRs) differ in postoperative rotator cuff tendon integrity and functional outcomes from degenerative RCRs.

Methods: RCRs performed by a single surgeon were retrospectively identified. The inclusion criteria were repairable Goutallier grades 0 to 2 full-thickness rotator cuff tears. Demographic and clinical data as well as radiological results were compared. A multivariate logistic regression of the of patient acceptable symptom state for American Shoulder and Elbow Surgeons (ASES) score was performed to evaluate whether the origin of tear led to a different relative risk (RR) independently from tear and surgical characteristics.

Results: A total of 616 consecutive shoulders (304 traumatic and 312 degenerative) were finally included. Traumatic ruptures presented a greater distribution of male (72% vs 51%, P < .001) and younger patients (53 vs 57 years, P < .001), as well as earlier onset of symptoms (3 vs 15 months, P < .001), reduced range of motion in preoperative assessment for forward elevation (130° vs 150°, P < .001), and slightly greater preoperative ASES (46.5 ± 19.7 vs 50.0 ± 18.0, P = .022) and Constant (47.0 ± 20.2 vs 52.0 ± 18.9, P = .001) scores. Degenerative tears presented a lower proportion of grade 3 tendon coronal retraction (11% vs 18%, P = .031). Postoperative tendon integrity at 6 months was comparable for both groups, predominantly Sugaya types 1 and 2 (91% traumatic; 92% degenerative, P = .371). Both groups exhibited favorable outcomes in range of motion and postoperative functional scores at last follow-up. The multivariate regression confirmed that the tear origin was not significantly associated with patient acceptable symptom state achievement (P = .201) but rather with greater preoperative ASES score (RR, 1.01), men (RR, 1.16) and workers' compensation (RR, 0.65) (P < .05).

Conclusions: Traumatic cases were frequent, involved younger patients, more frequently affected the anterior rotator cuff, and were associated with more severe tendon retraction. Traumatic and degenerative RCRs lead to comparable clinical and radiologic results.

Level of evidence: Level III, retrospective comparative study.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: FORE (Foundation for Research and Teaching in Orthopedics, Sports Medicine, Trauma, and Imaging in the Musculoskeletal System) Grant # FORE 2023-49. A.L. reports grants from Arthrex, during the conduct of the study; personal fees from Stryker, from null, outside the submitted work; and He is the (co)founder of FORE, Med4Cast, and BeeMed. P.C. reports personal fees from Arthrex, during the conduct of the study; and personal fees from Stryker and Fx Solution, outside the submitted work. All other authors (A.G.-A., E.A.V.R., H.B., J.Z., A.G.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

Figures

Fig 1
Fig 1
Right shoulder MRI, T2-weighted fat-saturated coronal view of a traumatic tendon shortening 2 months after a fall while hiking. Observe the residual stump at the greater tuberosity (B2 (midsubstance) lesions) (circle). The supraspinatus tendon has shortened (arrow). (MRI, magnetic resonance imaging.)
Fig 2
Fig 2
Arthroscopic characteristics of traumatic tendon tears, viewing posterolaterally from a right shoulder. Observe the stump of the remaining posterosuperior cuff on the greater tuberosity, tendon shredding, petechiae, and wavy form of torn rotator cuff edge, classical signs of traumatic tears.
Fig 3
Fig 3
Arthroscopic characteristic of a right degenerative tear, viewing from a posterolateral portal. The tendon is thinner and rounded, and there is no visible stump in the tuberosity.
See this image and copyright information in PMC

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