Review Question - QID 219778

Rotator Cuff Tears Treatment Operative QID: 219778 (SBQ24HW.11)

QID 219778 (Type "219778" in App Search)

A 35-year-old active male (5’10, 185lbs, BMI 26.5) presents for evaluation of severe left shoulder pain with difficulty sleeping on his left side. He states he initially developed sharp and severe left shoulder pain with mild weakness after attempting to lift a 50lb sandbag onto his left shoulder two weeks ago. On examination, he has tenderness over the anterolateral aspect of the shoulder, positive Jobe’s test, and passive shoulder flexion to 145 degrees, external rotation to 50 degrees, and internal rotation to L1. An MRI of the left shoulder was obtained (Figure A) and the patient is indicated for arthroscopic rotator cuff repair the following day. Which factor is most likely to impact this patient's postoperative clinical outcomes following repair of his traumatic rotator cuff tear?

Type & Select Correct Answer

Type in at least one full word to see suggestions list

BMI

21/849

Age

26%

217/849

Preoperative ASES score

30%

253/849

Male gender

46/849

Time to surgical repair

35%

301/849

Select Answer to see Preferred Response

The patient suffered a traumatic full-thickness rotator cuff, and as such, is indicated for operative intervention. Rotator cuff repair within three to four months of injury has been shown to significantly improve patient outcomes following rotator cuff repair of acute or traumatic, large rotator cuff tears with worse outcomes when repaired after 3-4 months from injury.

Early surgical repair of traumatic rotator cuff tears improves postoperative outcomes and pain scores compared to delayed surgical intervention after a course of nonoperative management. The standard treatment of rotator cuff tears is initially a course of nonoperative management, including physical therapy, nonsteroidal anti-inflammatory medications, and corticosteroid injections, followed by operative intervention in patients who fail nonoperative management. In the setting of young patients with traumatic, large rotator cuff tears, acute surgical repair within three weeks has been shown to provide superior clinical outcomes in this scenario.

Gutman et al. performed a retrospective review of 206 patients undergoing repair of traumatic full-thickness rotator cuff tears. The authors found patients undergoing repair within three weeks of injury demonstrated the greatest improvement in postoperative functional outcomes and pain scores, and patients undergoing repair after four months demonstrated significantly worse functional outcomes. Therefore, the authors concluded that patients with traumatic full-thickness rotator cuff tears demonstrated improved outcomes when repaired within three weeks.

Abdelwahab et al. performed a review of current concepts in the diagnosis and management of traumatic rotator cuff tears. The authors found rotator cuff tears occurring in patients under 40 years of age were likely to be traumatic in origin and reported high rates of pain relief and patient satisfaction postoperatively. They concluded that there was limited evidence to support the benefit of early repair of traumatic rotator cuff tears, but that this may be related to the difficulty of differentiating acute and acute on chronic tears.

Patel et al. reviewed outcomes following the repair of symptomatic traumatic rotator cuff tears stratified as early (within four months) or delayed (greater than four months). The authors found significantly longer times to full recovery for the delayed repair group, 33.8 months, versus acute repair, 14 months. Therefore, the authors concluded patients with traumatic rotator cuff tears would benefit from early operative repair.

Incorrect Answer:
Answers 1, 2, and 3: Patent BMI, age, and male gender have not been found to significantly impact postoperative functional outcomes and pain scores following the repair of traumatic full-thickness rotator cuff tears.
Answer 4: Higher preoperative ASES score is associated with greater improvement in postoperative VAS pain scores, but has not been found to impact postoperative functional outcomes.