The impact of surgical timing on functional improvement after arthroscopic repair of traumatic, full-thickness rotator cuff tears: is escalated care appropriate?

aim: We aimed to assess whether surgical timing relative to a 120-day threshold influences functional improvement following arthroscopic repair of traumatic, full-thickness rotator cuff tears. methods: The clinical records of consecutive patients undergoing primary arthroscopic repair of a traumatic, full-thickness rotator cuff tear by a single fellowship-trained shoulder surgeon between August 2016 and April 2023 were retrospectively reviewed. Patients without a confirmed traumatic injury mechanism, those with incomplete records and those with less than 12 months of post-operative follow-up were excluded. Eligible patients were allocated into an early group (surgery ≤120 days from injury, n=28) and a late group (surgery >120 days, n=50). The primary outcome was post-operative change in Oxford Shoulder Score (OSS). results: There were no significant differences between the groups in baseline demographic or surgical characteristics (all p>0.05). The early group had a significantly lower pre-operative OSS than the late group (mean 21.8 vs 27.5; p=0.012); however, post-operative OSS was not significantly different between groups (mean 46.4 vs 43.6; p=0.063). The early group demonstrated a significantly greater improvement in OSS (mean +24.6 vs +16.1 points; p<0.001). On multivariate analysis, time from injury to surgery was an independent predictor of post-operative change in OSS (p<0.001). No significant between-group differences were identified for pain visual analogue scale (VAS), EQ-5D VAS or EQ-5D index. conclusion: Arthroscopic repair of traumatic, full-thickness rotator cuff tears within 120 days of injury is associated with significantly greater improvement in shoulder-specific function compared with delayed repair. These results support the introduction of escalated care pathways to facilitate timely surgical access for patients sustaining traumatic rotator cuff tears.