Skip to main content
SpringerLink
Log in

Comparison of tear characteristics, outcome parameters and healing in traumatic and non-traumatic rotator cuff tear: a prospective cohort study

  • Original Article
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Purpose

Acute traumatic and chronic non-traumatic rotator cuff tears are etiologically distinguishable entities. However, prospective studies comparing tear characteristics and outcomes between these two types of tears are lacking. The purpose of this study was to compare the tear characteristics, clinical and functional outcomes, and tendon healing as assessed on magnetic resonance imaging (MRI), between traumatic and non-traumatic rotator cuff tears.

Methods

MRI proven rotator cuff tears were allocated into two groups according to the history of injury: Group 1 included 28 patients with traumatic tears and group 2 included 33 patients of non-traumatic cuff tears. Both the groups were compared for preoperative tear characteristics (tear size, muscle atrophy, fatty degeneration), range of motion, strength of shoulder abduction and external rotation, functional outcomes, and tendon integrity on MRI, 2 years after the surgery.

Results

Postoperative mean active range of abduction (p = 0.005), abduction strength (p = 0.013), external rotation strength (p = 0.027), University of California at Los Angeles score (p < 0.001), Constant score (p = 0.002), American Shoulder and Elbow Surgeons scores (p = 0.028) and visual analog scale for pain (p = 0.02) were significantly better in group 1 as compared to group 2. The postoperative structural integrity of the cuff on MRI was better in group 1 as compared to group 2, but the values did not reach statistical significance (p = 0.13).

Conclusion

Findings from this study suggest that traumatic tears affect younger patients and while having a larger tear size, they have lesser muscle atrophy, fatty degeneration, and tendon retraction. Functional outcomes are better after treatment of traumatic tears as compared to non-traumatic tears. Chronicity of the tear and tendon retraction negatively affected healing in traumatic cuff tears. Muscle atrophy was found to be associated with poorer healing in non-traumatic tears. However, tear size was not associated with healing.

Level of evidence

II, Prospective cohort study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Via AG, De Cupis M, Spoliti M, Oliva F (2013) Clinical and biological aspects of rotator cuff tears. Muscles Ligaments Tendons J 3:70. https://doi.org/10.11138/MLTJ/2013.3.2.070

    Article  PubMed  Google Scholar 

  2. Lazarides AL, Alentorn-Geli E, Choi JHJ et al (2015) Rotator cuff tears in young patients: a different disease than rotator cuff tears in elderly patients. J Shoulder Elb Surg 24:1834–1843. https://doi.org/10.1016/j.jse.2015.05.031

    Article  Google Scholar 

  3. Loew M, Magosch P, Lichtenberg S et al (2015) How to discriminate between acute traumatic and chronic degenerative rotator cuff lesions: an analysis of specific criteria on radiography and magnetic resonance imaging. J Shoulder Elb Surg 24:1685–1693. https://doi.org/10.1016/j.jse.2015.06.005

    Article  Google Scholar 

  4. Braune C, von Eisenhart-Rothe R, Welsch F et al (2003) Mid-term results and quantitative comparison of postoperative shoulder function in traumatic and non-traumatic rotator cuff tears. Arch Orthop Trauma Surg 123:419–424. https://doi.org/10.1007/s00402-003-0548-2

    Article  PubMed  Google Scholar 

  5. Tan M, Lam PH, Le BTN, Murrell GAC (2016) Trauma versus no trauma: an analysis of the effect of tear mechanism on tendon healing in 1300 consecutive patients after arthroscopic rotator cuffrepair. J Shoulder Elb Surg 25:12–21. https://doi.org/10.1016/j.jse.2015.06.023

    Article  CAS  Google Scholar 

  6. Kukkonen J, Joukainen A, Itälä A, Äärimaa V (2013) Operatively treated traumatic versus non-traumatic rotator cuff ruptures: a registry study. Upsala J Med Sci 118:29–34. https://doi.org/10.3109/03009734.2012.715597

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kitagaki Abechain JJ, Godinho GG, Matsunaga FT et al (2017) Functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair. World J Orthop 8:631–637. https://doi.org/10.5312/wjo.v8.i8.631

    Article  PubMed  Google Scholar 

  8. Sugaya H, Maeda K, Matsuki K, Moriishi J (2005) Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthrosc J Arthrosc Relat Surg 21:1307–1316. https://doi.org/10.1016/j.arthro.2005.08.011

    Article  Google Scholar 

  9. Teratani T (2017) Comparison of the epidemiology and outcomes of traumatic and nontraumatic rotator cuff tears. J Orthop 14:166–170. https://doi.org/10.1016/j.jor.2016.12.007

    Article  PubMed  PubMed Central  Google Scholar 

  10. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Article  Google Scholar 

  11. Amstutz HC, Sew Hoy AL, Clarke IC (1981) UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res 155:7–20. https://doi.org/10.1097/00003086-198103000-00002

    Article  Google Scholar 

  12. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med 29:602–608. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6%3c602::AID-AJIM4%3e3.0.CO;2-L

    Article  PubMed  CAS  Google Scholar 

  13. Richards RR, An KN, Bigliani LU et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elb Surg 3:347–352. https://doi.org/10.1016/S1058-2746(09)80019-0

    Article  CAS  Google Scholar 

  14. Goutallier D, Postel JM, Gleyze P et al (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elb Surg 12:550–554. https://doi.org/10.1016/S1058-2746(03)00211-8

    Article  Google Scholar 

  15. Zanetti M, Gerber C, Hodler J (1998) Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Investig Radiol 33:163–170. https://doi.org/10.1097/00004424-199803000-00006

    Article  CAS  Google Scholar 

  16. Kukkonen J, Kauko T, Vahlberg T et al (2013) Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elb Surg 22:1650–1655. https://doi.org/10.1016/j.jse.2013.05.002

    Article  Google Scholar 

  17. Hantes ME, Karidakis GK, Vlychou M et al (2011) A comparison of early versus delayed repair of traumatic rotator cuff tears. Knee Surg Sport Traumatol Arthrosc 19:1766–1770. https://doi.org/10.1007/s00167-011-1396-1

    Article  Google Scholar 

  18. Russell RD, Knight JR, Mulligan E, Khazzam MS (2014) Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. J Bone Jt Surg Ser A 96:265–271. https://doi.org/10.2106/JBJS.M.00265

    Article  Google Scholar 

  19. Mall NA, Lee AS, Chahal J et al (2013) An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears. Arthrosc J Arthrosc Relat Surg 29:366–376. https://doi.org/10.1016/j.arthro.2012.06.024

    Article  Google Scholar 

  20. Tashjian RZ (2012) Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med 31:589–604. https://doi.org/10.1016/j.csm.2012.07.001

    Article  PubMed  Google Scholar 

  21. Lenza M, Buchbinder R, Takwoingi Y et al (2013) Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev 2013(9):CD009020

  22. Yoshida M, Collin P, Josseaume T et al (2018) Post-operative rotator cuff integrity, based on Sugaya’s classification, can reflect abduction muscle strength of the shoulder. Knee Surg Sport Traumatol Arthrosc 26:161–168. https://doi.org/10.1007/s00167-017-4608-5

    Article  Google Scholar 

  23. Petersen SA, Murphy TP (2011) The timing of rotator cuff repair for the restoration of function. J Shoulder Elb Surg 20:62–68. https://doi.org/10.1016/j.jse.2010.04.045

    Article  Google Scholar 

  24. Deniz G, Kose O, Tugay A et al (2014) Fatty degeneration and atrophy of the rotator cuff muscles after arthroscopic repair: does it improve, halt or deteriorate? Arch Orthop Trauma Surg 134:985–990. https://doi.org/10.1007/s00402-014-2009-5

    Article  PubMed  Google Scholar 

  25. Gladstone JN, Bishop JY, Lo IKY, Flatow EL (2007) Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35:719–728. https://doi.org/10.1177/0363546506297539

    Article  PubMed  Google Scholar 

  26. Codding JL, Keener JD (2018) Natural history of degenerative rotator cuff tears. Curr Rev Musculoskelet Med 11:77–85

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mall NA, Tanaka MJ, Choi LS, Paletta GA (2014) Factors affecting rotator cuff healing. J Bone Jt Surg Am 96:778–788. https://doi.org/10.2106/JBJS.M.00583

    Article  Google Scholar 

  28. Oh JH, Kim SH, Choi JA et al (2010) Reliability of the grading system for fatty degeneration of rotator cuff muscles. Clin Orthop Relat Res 468:1558–1564. https://doi.org/10.1007/s11999-009-0818-6

    Article  PubMed  Google Scholar 

  29. Keener JD, Patterson BM, Orvets N, Chamberlain AM (2019) Degenerative rotator cuff tears. J Am Acad Orthop Surg 27:156–165. https://doi.org/10.5435/JAAOS-D-17-00480

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India

    S. Paul & A. K. Yadav

  2. Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India

    T. Goyal

Authors
  1. S. Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. K. Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Goyal.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by institutional review board (AIIMS/IEC/19/693).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paul, S., Yadav, A.K. & Goyal, T. Comparison of tear characteristics, outcome parameters and healing in traumatic and non-traumatic rotator cuff tear: a prospective cohort study. Musculoskelet Surg 106, 433–440 (2022). https://doi.org/10.1007/s12306-021-00719-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-021-00719-6

Keywords

Search

Navigation