Early Repair of Traumatic Massive Rotator Cuff Tears Improves Functional Outcomes Compared With Delayed Repair

PURPOSE: To compare the postoperative American Shoulder and Elbow Surgeons (ASES) score and tendon integrity after early versus delayed arthroscopic repair of traumatic massive rotator cuff tears (RCTs). METHODS: This retrospective cohort study included patients with traumatic massive RCTs who underwent arthroscopic treatment between November 2020 and May 2023. The inclusion criteria were as follows: (1) meeting the definition of traumatic RCT, (2) preoperative and 2-year postoperative magnetic resonance imaging examinations, (3) patients with massive RCTs confirmed by arthroscopy, and (4) patients with at least 2 years of clinical follow-up. Patients were divided into an early repair group (<3 weeks after injury) and a delayed repair group (≥3 weeks after injury). The ASES score was used to assess functional outcomes. Magnetic resonance imaging was used to assess tendon integrity. The minimal clinically important difference (MCID) was calculated based on the ΔASES scores, and the proportion of patients exceeding the MCID threshold was determined. A linear regression model was employed to evaluate whether the timing of surgery remained independently associated with postoperative ASES scores after adjusting for confounding factors. Logistic regression analysis was used to explore factors associated with retears. RESULTS: A total of 78 patients met the inclusion criteria (42 in the early repair group and 36 in the delayed repair group). The baseline demographic characteristics of the 2 groups were comparable (mean age: 53.6 vs 56.2 years; female proportion: 40.5% vs 50.0%; mean follow-up duration: 37.8 vs 35.8 months). Postoperatively, the ASES score was higher in the early repair group than in the delayed repair group (86.5 ± 6.7 vs 80.4 ± 8.2), and ASES improvement was also greater in the early group (60.4 ± 8.7 vs 53.1 ± 11.0). The cohort-specific ASES MCID for change scores was 5.2 points, and 100% of patients achieved the MCID in both groups (early, 42/42; delayed, 36/36). Multivariate linear regression analysis showed that after adjusting for age, sex, Charlson Comorbidity Index score, and baseline score, delayed repair remained independently associated with a lower postoperative ASES score (regression coefficient β = -6.33; 95% confidence interval: -9.71 to -2.96). There was no statistically significant difference in the retear rate between the early repair group and the delayed repair group (38.1% vs 52.8%). Multivariate logistic regression analysis revealed that after adjusting for age, sex, Charlson Comorbidity Index, smoking history, and diabetes status, surgical timing was not an independent factor associated with retear (odds ratio = 1.63; 95% confidence interval: 0.61-4.35). CONCLUSIONS: Early arthroscopic repair for traumatic massive RCTs yields better functional outcomes compared with delayed repair. All patients achieved MCID-level improvement in ASES, irrespective of surgical timing. Retear rates were not statistically different between groups, although the study was underpowered to exclude a clinically relevant difference. LEVEL OF EVIDENCE: Level III, retrospective comparative case series.