Definition of the terms “acute” and “traumatic” in rotator cuff injuries: a systematic review and call for standardization in nomenclature

Abstract

Background Although of high relevance for clinical decision making, there exists no consensus throughout the literature of the terms “acute” and “traumatic” used in the classification of rotator cuff tears. With differing definitions, the comparability of outcome studies may be limited. The aim was to provide a detailed systematic review of the definitions used in the literature and present a suggestion for a standardization in nomenclature based on the findings. Methods Four different internet databases were searched in February 2020 using the terms (“acute” OR “traumatic” OR “trauma” OR “athlete” OR “young”) AND (“rotator cuff tears” OR “rotator cuff tear” OR “rotator cuff” OR “rotator cuff rupture” OR “supraspinatus” OR “infraspinatus” OR “subscapularis” OR “teres minor”). Prospective, retrospective, cohort and case–control studies as well as case series were included. Systematic reviews, cadaveric or laboratory studies and studies on non-traumatic or non-acute rotator cuff tears were excluded. Results The literature search conducted 10,349 articles of which 10,151 were excluded based on the title, 119 based on the abstract and 33 based on the manuscript. A total of 46 studies were finally included for review and subsequently analyzed. Overall, there exists no consensus neither on the term “acute” nor on “traumatic” in the context of rotator cuff tears in the literature. The time span for acute injuries ranged between 2 weeks and 6 months. For traumatic injuries, only 20% of the selected studies described a specific and adequate injury mechanism in combination with adequate imaging. Conclusion The term “acute” should be reserved for RCT showing muscle edema, wavelike appearance of the central part of the torn tendon and joint effusion, which typically requires adequate imaging within 2 weeks from trauma. Repair of acute tears should occur within 8 weeks from trauma to benefit from possibly superior biological healing capacities. The term “traumatic” should be used for a sudden onset of symptoms in a previously asymptomatic patient, triggered by an adequate trauma, e.g., a fall on the retroverted arm with an axial cranioventral force or a traumatic shoulder dislocation.

What Factors Are Associated with Symptomatic Rotator Cuff Tears: A Meta-analysis

“…Of course, surgeons (and internists) should continue to help patients achieve good blood pressure control, and future studies can explore whether blood pressure control can delay the pathological progression of rotator cuff tears. A history of shoulder trauma has been considered a risk factor for rotator cuff tears [19,51], as confirmed by our meta-analysis. The number of rotator cuff tears in patients younger than 45 years is increasing because of trauma [6,38].…”

Comparison of Functional Outcomes After Arthroscopic Rotator Cuff Repair Between Patients With Traumatic and Atraumatic Tears

“…Delineation of traumatic versus degenerative tear was based on patient history of traumatic event and muscular edema on MRI scans. 23 , 31 To be considered traumatic in nature, patients had to report a specific trauma related to the onset of correlating symptoms, with an adequate injury mechanism. Acute traumatic tears were confirmed via the presence of muscle edema on MRI scans.…”

Full-Thickness Rotator Cuff Tears Can Be Safely Treated With a Resorbable Bioinductive Bovine Collagen Implant: One-Year Results of a Prospective, Multicenter Registry

“…However, there is an emerging consensus that these terms do not accurately reflect the often overlapping and complex causes of rotator cuff tears. 27 Even tears with traumatic origins have been shown to have existing pathologic evidence of degeneration, providing the means for the tears to occur. 28 There has also been a shift in how best to treat rotator cuff tears.…”