How Much Does Delay Increase Rotator Cuff Re-Tear Risk?

According to a new study, while a small surgery delay after a rotator cuff injury doesn’t necessarily increase the risk of a rotator cuff re-tear, waiting a year or more does.

In the study, “Role of Delay Between Injury and Surgery on the Outcomes of Rotator Cuff Repair: A Systematic Review and Meta-analysis,” the researchers investigate if a delay in surgery affected the outcomes of rotator cuff repair.

The findings were published online on January 31, 2022, in The American Journal of Sports Medicine.

“Outcomes of rotator cuff repair are influenced by several well-described factors, but the role of delay from injury to surgery on the outcomes is not clear,” the researchers wrote.

They conducted a systematic review and meta-analyses of available research that assessed outcomes after rotator cuff repair and whether there was a delay in surgery. Important inclusion criteria were traumatic injuries, mean age less than 65 years, minimum 6-month follow-up, and assessment of retear rates with radiologic examination or reporting of patient-reported outcome measures.

The researchers identified 33 relevant studies with 8,118 patients. The mean age of patients was 59 years. The mean follow-up was 3.0 years (range, 0.5-8.2). A majority of the patients had a dominant-side injury.

The data showed that patients who had surgery longer than 3 months after surgery did not have higher retear rates (OR, 1.1 [95% CI, 0.5 to 3.1]; p = .700), lower Constant-Murley score (MD, -6.2 [95% CI, -16.4 to 4.1]; p =  .240) or lower American Shoulder and Elbow Surgeons score; MD, -12.9 [95% CI, -26.0 to -0.2]; p = .050) compared with patients who had their surgery within three months of injury.

Delaying surgery for 6 months also didn’t negatively impact retear rates or patient-reported outcome measures (p = .190). A year long delay, however, did lead to an increased likelihood of retear when compared with less than a year (OR, 2.9 [95% CI, 2.1 to 4.0]; p < .001).

In addition, patients who never experienced a retear by follow-up had a mean 3.9 month shorter time to surgery than patients with retear (95% CI, 1.0-6.8 months; p = .009).

The researchers wrote, “This systematic review with meta-analysis found that delaying rotator cuff surgery for 3 to 6 months did not lead to higher retear rates or inferior patient-reported outcome measures as compared with undergoing earlier surgery. However, delaying surgery for a year or longer clearly resulted in higher retear rates after rotator cuff repair. This study is limited by relying on retrospective studies, and larger prospective studies are needed to confirm these findings.”

The study authors include Jelle P. van der List, M.D., Laura M. Kok, M.D., Tiarco D.W. Alta, M.D., and Arthur van Noort, M.D., of Spaarne Gasthuis, Hoofddorp, the Netherlands. Maarten P.J. van der List of the Bergman Clinics, Naarden, the Netherlands was also involved in the research.