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Early rotator cuff surgery can improve long-term outcomes

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Early surgery to repair a tear of one of the shoulder rotator cuff muscles can provide improvement in strength, function and other outcomes over the long term, new research reveals.

Most rotator cuff tears start within the supraspinatus tendon, and the new study provides evidence that early surgery for supraspinatus tears helps to prevent later rotator cuff muscle degeneration.

The findings have been published in the Journal of Bone & Joint Surgery.

A French orthopaedic surgery research group examined the cases of 288 patients who underwent surgery in 2003 to repair isolated, complete (full-thickness) supraspinatus tears and returned at least ten years later for follow-up evaluation, including magnetic resonance imaging (MRI) scans in 210 patients. The patients’ average age at the time of surgery was 56.5 years, with nearly equal numbers of women and men.

Outcomes were similar for patients who had open surgery and those who had arthroscopic (minimally invasive) surgery, and most patients showed a substantial improvement. The average Constant score — a standard assessment which takes account of shoulder motion, strength, daily activities and pain — improved from about 52 (out of a possible 100) before surgery to 78 at follow-up.

The MRI scans showed healing in more than 80% of tendons, although most had at least a minor residual tear. The researchers noted that MRI evidence of tendon healing was closely related to the Constant score, especially in terms of strength.

In all, 30 shoulders (10.4%) had complications, including stiffness (20 shoulders), infection (1 shoulder) and other complications (9 shoulders).

Healing and recovery were not as good in patients who had MRI evidence of fat accumulation within the repaired muscle — a sign of muscle degeneration.

The results suggest that early surgery for rotator cuff tears leads to lasting improvement in healing and clinical outcomes, the researchers concluded.