Functional Outcomes of Early vs. Delayed Arthroscopic Repair for Traumatic and Degenerative Rotator Cuff Tears: A Retrospective Cohort Study

<b>Background/Objectives</b>: The optimal surgical timing for rotator cuff tears (RCTs) remains controversial, particularly regarding how tear etiology influences the final functional recovery. This study aimed to compare the clinical outcomes of early versus delayed arthroscopic repair stratified by etiology, providing evidence for etiology-specific surgical timing. <b>Methods</b>: A retrospective cohort study was conducted on 183 patients who underwent arthroscopic rotator cuff repair for isolated full-thickness supraspinatus tears. Patients were stratified into traumatic (<i>n</i> = 74) and degenerative (<i>n</i> = 109) groups based on etiology. They were further divided into early-repair and delayed-repair subgroups based on symptom duration (traumatic cut-off: 3 months; degenerative cut-off: 6 months). Clinical outcomes were assessed preoperatively and at the final follow-up using the Visual Analog Scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score, and range of motion. Complications, including retear rates and stiffness, were recorded. <b>Results</b>: In the traumatic group, early repair yielded significantly better postoperative pain relief (VAS) and higher functional scores (ASES and UCLA) compared to delayed repair. Notably, the delayed traumatic group exhibited a significantly higher retear rate compared to the early group (16.7% vs. 2.6%; <i>p</i> = 0.039). Conversely, in the degenerative group, comparisons between early and delayed repair revealed no significant differences in the final functional scores, pain levels, or complication rates (<i>p</i> > 0.05). <b>Conclusions</b>: Surgical timing significantly impacts outcomes in traumatic RCTs, where early repair is critical to optimize functional recovery and minimize retear risks. In contrast, delayed arthroscopic repair for degenerative tears yielded comparable outcomes to early repair, suggesting that an initial trial of conservative management is safe and does not compromise final surgical outcomes.