Author's personal copy Systematic Review With Video Illustration An Evidenced-Based Examination of the Epidemiology and Outcomes of Traumatic Rotator Cuff Tears

Purpose: The purpose of this study was to systematically review the literature to better define the epidemiology, mechanism of injury, tear characteristics, outcomes, and healing of traumatic rotator cuff tears. A secondary goal was to determine if sufficient evidence exists to recommend early surgical repair in traumatic rotator cuff tears. Methods: An independent systematic review was conducted of evidence Levels I to IV. A literature search of PubMed, Medline, Embase, and Cochrane Collaboration of Systematic Reviews was conducted, with 3 reviewers assessing studies for inclusion, methodology of individual study, and extracted data. Results: Nine studies met the inclusion and exclusion criteria. Average patient age was 54.7 (34 to 61) years, and reported mean time to surgical intervention, 66 days (3 to 48 weeks) from the time of injury. The most common mechanism of injury was fall onto an outstretched arm. Supraspinatus was involved in 84 % of tears, and infraspinatus was torn in 39 % of shoulders. Subscapularis tears were present in 78 % of injuries. Tear size was <3 cm in 22%, 3 to 5 cm in 36%, and>5 cm in 42%. Average active forward elevation improved from 81 to 150 postoperatively. The weighted mean postoperative UCLA score was 30, and the Constant score was 77. Conclusions: Traumatic rotator cuff tears are more likely to occur in relatively young (age 54.7), largely male patients who suffer a fall or trauma to an abducted, externally rotated arm. These tears are typically large and involve the sub-scapularis, and repair results in acceptable results. However, insufficient data prevent a firm recommendation for early surgical repair. Level of Evidence: Level IV, systematic review Levels III and IV studies