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Factors Affecting Surgery for Rotator Cuff Tear

Surgical repair of rotator cuff tears (RCTs) is now common. Research to support the best timing and reasons to do the surgery are few and far between. In this study, researchers from the Hospital for Special Surgery in New York City conducted a review of 50 articles published on the topic.

They put together a list of questions they were seeking answers to. For example:

  • Do patient characteristics such as age, gender, and type of work affect the results of treatment for RCT?
  • Does it matter how long the tear has been present before treatment is started?
  • Are there any factors that can predict the result of treatment?
  • Who should be offered surgery? How soon after the tear occurs?

    Overall they found that RCTs increase dramatically with age. Worse results occur in older adults. Women and patients with pending workers' compensation claims had poorer results.

    But in general, after reviewing available studies, there were more unknowns than knowns to answer their questions. For example, there's no agreement on when to treat RCTs nonoperatively. Likewise, it's not clear how long nonoperative care should last.

    Animal studies suggest that changes in the rotator cuff after an injury may mean healing isn't possible. Pockets of fat fill the damaged area. Muscles around the shoulder atrophy and lose strength. Some of these changes can't be changed or reversed. And patients who have more than three steroid injections into the shoulder may have additional irreversible damage.

    Until further studies can be done, the authors summarize their recommendations as follows:

  • Six weeks to three months of physical therapy and antiinflammatory drugs is a safe and reasonable place to start after painful, full-thickness RCTs.
  • Nonoperative care often fails when symptoms persist beyond one year.
  • Operative repair is advised if the patient is not helped by conservative
    (nonoperative) care.
  • Age and gender should not affect treatment decisions.
  • Surgery is best done early for acute RCTs from trauma.
  • Very active patients are more likely to need surgery in order to regain motion and strength.
    • Reference: 

    Luke S. Oh, MD, MS, et al. Indications for Rotator Cuff Repair. In Clinical Orthopaedics and Related Research. February 2007. No. 455. Pp. 52-63.

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