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      Time to surgery in acute rotator cuff tear : A systematic review

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          Abstract

          Aims

          We performed a systematic review of the literature to determine whether earlier surgical repair of acute rotator cuff tear (ARCT) leads to superior post-operative clinical outcomes.

          Methods

          The MEDLINE, Embase, CINAHL, Web of Science, Cochrane Libraries, controlled-trials.com and clinicaltrials.gov databases were searched using the terms: ‘rotator cuff’, or ‘supraspinatus’, or ‘infraspinatus’, or ‘teres minor’, or ‘subscapularis’ AND ‘surgery’ or ‘repair’. This gave a total of 15 833 articles. After deletion of duplicates and the review of abstracts and full texts by two independent assessors, 15 studies reporting time to surgery for ARCT repair were included. Studies were grouped based on time to surgery < 3 months (group A, seven studies), or > 3 months (group B, eight studies). Weighted means were calculated and compared using Student’s t-test.

          Results

          Group B had a significantly higher pre-operative Constant score (CS) (p < 0.001), range of movement in external rotation (p = 0.003) and abduction (p < 0.001) compared with group A. Both groups showed clinical improvement with surgical repair; group A had a significantly improved Constant score, University of California, Los Angeles (UCLA) shoulder score, abduction and elevation post-operatively (all p < 0.001). Group B had significantly improved Constant score (p < 0.001) and external rotation (p < 0.001) post-operatively. The mean Constant score improved by 33.5 for group A and by 27.5 for group B.

          Conclusion

          These findings should be interpreted with caution due to limitations and bias inherent to case-series. We suggest a trend that earlier time to surgery may be linked to better Constant score, and active range of movement in abduction and elevation. Additional prospective studies are required.

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          Most cited references18

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          A clinical method of functional assessment of the shoulder.

          C. R. Constant, A H Murley (1987)
          Several methods have been devised to estimate shoulder function, none of which is entirely satisfactory. The method described in this article is applicable irrespective of the details of the diagnostic or radiologic abnormalities caused by disease or injury. The method records individual parameters and provides an overall clinical functional assessment. It is accurately reproducible by different observers and is sufficiently sensitive to reveal even small changes in function. The method is easy to perform and requires a minimal amount of time for evaluation of large population groups.
          Article 0 comments Cited 277 times – based on 0 reviews     Review now
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            American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness.

            Lori Michener, Philip W McClure, Brian Sennett (2002)
            The purpose of this study was to examine the psychometric properties of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), patient self-report section. Patients with shoulder dysfunction (n = 63) completed the ASES, The University of Pennsylvania Shoulder Score, and the Short Form-36 during the initial evaluation, 24 to 72 hours after the initial visit, and after 3 to 4 weeks of physical therapy. The test-retest reliability (intraclass correlation coefficient[1-way random-effects], 0.84; 95% CI lower limit, 0.75) and internal consistency (Cronbach alpha, 0.86) values were acceptable. The standard error of the measure was 6.7 ASES points (90% CI, 11.0). Construct and discriminant validity was demonstrated. Responsiveness was demonstrated with a standardized response mean of 1.5 and an effect size of 1.4. The minimal detectable change was 9.7 ASES points (90% CI, 16), and the minimal clinically important difference was 6.4 ASES points. The results indicate that the ASES is a reliable, valid, and responsive outcome tool.
            Article 0 comments Cited 215 times – based on 0 reviews     Review now
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              Diagnosis and treatment of anterosuperior rotator cuff tears.

              J Warner, Sahran Higgins, I M Parsons … (2016)
              Nineteen of 407 patients who underwent rotator cuff repair surgery over a 6-year period were found to have a tear of the subscapularis in combination with the supraspinatus and infraspinatus tendons. Nine of these patients had an unsuccessful prior surgery, which failed to recognize the extent of the subscapularis component. Surgical repair of the subscapularis tendon required a deltopectoral approach, and repair of the supraspinatus and infraspinatus components of the tear could only be accomplished through this approach in 4 patients. In the remaining 15, an extended superior approach was required to mobilize and repair the supraspinatus and infraspinatus tendons. In all cases, the biceps tendon was either torn or severely degenerated, requiring tenodesis. At a mean follow-up of 40 months (range 24 to 75 months), subjective results were excellent in 5 patients, good in 3, fair in 4, and poor in 7. The modified Constant score improved to a mean of 69% (range 23% to 130%), compared with a preoperative mean of 38% (range 23% to 100%). Physical findings positive for subscapularis insufficiency persisted in 14 of 19 patients. A significant correlation (P <.05) was found between a lower Constant score and duration of symptoms longer than 6 months as well as an appearance of severe fatty degeneration and atrophy of the subscapularis muscle on magnetic resonance imaging. We conclude that anterosuperior rotator cuff tears are an infrequent configuration that may require surgical repair through an extended approach combining deltopectoral mobilization of the subscapularis with transdeltoid mobilization of the supraspinatus and infraspinatus. Repair before 6 months of symptoms is associated with a better functional outcome and is the result of less involution of muscle and tendon tissue.
              Article 0 comments Cited 67 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                I. Mukovozov: Role: Trainee URI : http://orthodox.boneandjoint.org.uk/viewprofileinfo.aspx?authorid=1008286
                S. Byun: Role: Trainee
                F. Farrokhyar: Role: Associate Clinical Professor
                I. Wong: Role: Orthopaedic Surgeon URI : http://orthodox.boneandjoint.org.uk/viewprofileinfo.aspx?authorid=1005584
                Journal
                Journal ID (nlm-ta): Bone Joint Res
                Journal ID (iso-abbrev): Bone Joint Res
                Title: Bone & Joint Research
                Publisher: British Editorial Society of Bone and Joint Surgery
                ISSN (Print): 2046-3758
                ISSN (Electronic): 2046-3758
                Publication date Collection: July 2013
                Publication date (Electronic): 01 July 2013
                Volume: 2
                Issue: 7
                Pages: 122-128
                Affiliations
                [1 ]University of Toronto, Faculty of Medicine, 1 King’s College Circle, Toronto, Ontario, M5S 1A8, Canada.
                [2 ]Michael G. DeGroote School of Medicine, McMaster University, 401 Main Street West, Hamilton, Ontario, L8P 1K5, Canada.
                [3 ]McMaster University, Department of Surgery and Department of Clinical Epidemiology & Biostatistics, 39 Charlton Avenue East Room 107, Hamilton, Ontario, L8N 1Y3, Canada.
                [4 ]Dalhousie University, Department of Surgery, Division of Orthopaedic Surgery, 5655 Veteran’s Memorial Building Room 2106, Halifax, Nova Scotia, B3H 2E1, Canada.
                Author notes
                Correspondence should be sent to Mr I. Mukovozov; e-mail: ilya.mukovozov@ 123456utoronto.ca
                Article
                Publisher ID: 2000164
                DOI: 10.1302/2046-3758.27.2000164
                PMC ID: 3701252
                PubMed ID: 23836477
                SO-VID: 775483b2-98db-4a69-92bc-9a08200e011d
                Copyright © ©2013 The British Editorial Society of Bone & Joint Surgery
                License:

                ©2013 The British Editorial Society of Bone & Joint Surgery. This is an open-access article distributed under the terms of the Creative Commons Attributions licence, which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.

                History
                Date received : 02 February 2013
                Date accepted : 01 May 2013
                Funding
                None declared
                Categories
                Subject: Upper Limb
                Subject: 4
                Subject: Time to Surgery
                Subject: Acute Rotator Cuff Tear
                Subject: Systematic Review
                Subject: Rotator Cuff
                Subject: Supraspinatus
                Subject: Infraspinatus
                Subject: Teres Minor
                Subject: Subscapularis
                Subject: Surgery
                Subject: Repair
                Subject: Acute Tear
                Custom metadata
                odf2nlm-version 1.0
                price $2.00
                principal-institution Dalhousie University, Halifax, Nova Scotia, Canada
                article-type Research
                coi-statement None declared

                Keywords: time to surgery,acute rotator cuff tear,systematic review,rotator cuff,supraspinatus,infraspinatus,teres minor,subscapularis,surgery,repair,acute tear
                Data availability:
                Keywords: time to surgery, acute rotator cuff tear, systematic review, rotator cuff, supraspinatus, infraspinatus, teres minor, subscapularis, surgery, repair, acute tear

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