It is known that young-age RCTs are more likely to occur on the basis of trauma.8 In our study, in which we examined the change of retraction and atrophy levels according to time in young patients with traumatic full-thickness SS rupture, it was determined that there was a moderate positive correlation between the elapsed time with the retraction level, and a strong positive correlation with atrophy levels (r = 0.599, r = 0.751, respectively). In addition, a statistically significant difference was observed between the 1–3 month and 3–6 months groups (p = 0.032 [retraction], p = 0.002 [atrophy]), while the difference was not statistically significant between the 3–6 month and 6–12 months groups (p = 0.118 [retraction], p = 0.057 [atrophy]).
Thompson et al.17 compared the MR images of 143 patients without a tear in the SS tendon and 148 patients with tendon retraction accompanying a full-thickness tear. The relationship between tendon retraction and atrophy level was evaluated according to the Goutallier classification. It was determined that there was a statistically significant increase in the Goutallier level in the rupture group (p < 0.001) and the increase in the Goutallier level was associated with retraction (p < 0.001). Similarly, in the current study, a moderate positive correlation was found between increased atrophy levels and tendon retraction (r = 0.668).
A systematic review stating that the definition of "acute and/or traumatic RCT" is contradictory in the literature, is aimed to provide a standard definition for these expressions.20 The 18 articles reviewed in this review were divided into two groups, 10 studies using a minimum duration of two to a maximum of six weeks for acute RCTs, and eight studies using a duration of two to six months. In a randomized controlled trial with level-1 evidence cited in the same review, Ranebo et al.21 used the 3-month limit for 58 patients. In our study, we divided the traumatic full-thickness isolated SS rupture patients into four different time groups in order not to use the contradictory "acute" expression with precise time intervals.
Petersen et al.15 in their study examining the functions of acute traumatic full-thickness RCTs, it was reported that fat atrophy and tear size were not associated with postoperative function if repaired before four months. Similarly, Patel et al.16 reported that repairing acute traumatic full-thickness RCTs within four months of injury gave better results. In the current study, there was a statistically significant difference between the 2nd group (1–3 months) and the 3rd group (3–6 months) (p = 0.032 [retraction], p = 0.002 [atrophy]), while the absence of a significant difference between the 3rd group and the 4th group (6–12 months) (p = 0.118 [retraction], p = 0.057 [atrophy]) supports this situation. In addition, when the 3rd group (3–6 months) was divided into 3 groups and compared, a statistically significant increase was found in atrophy levels when it was passed from 3–4 months to 4–5 months (p = 0.015).
Braune et al.22 showed that isolated subscapularis rupture, biceps tendinitis, and subluxation were detected more frequently in the traumatic group in a study comparing the macroscopic appearance of traumatic and nontraumatic RCT. In our study, isolated SS ruptures were evaluated, and the presence of other rotator cuff pathologies was an exclusion criterion. Subscapularis ruptures can be planned as an additional study.
Paul et al.23 in a study comparing traumatic and non-traumatic RCTs, stated that traumatic tears are more common in younger patients and show less muscle atrophy, fat degeneration, and tendon retraction, although they are seen in larger tear sizes. Accordingly, our study included patients under 40 years of age, and the retraction and atrophy levels of traumatic SS ruptures were evaluated according to the time of injury. In this study, time after trauma was highly correlated with the level of retraction and atrophy (r = 0.599 [retraction], r = 0.751 [atrophy]), but no comparison was made with non-traumatic ruptures.
Gilbert et al.18 in a study, they conducted with full-thickness SS ruptures, examined the relationship of fatty degeneration with tendon thickness and retraction. They stated that fatty degeneration showed a positive correlation with tendon retraction and a negative correlation with tendon thickness. In the current study, there was a moderate correlation between tendon retraction and atrophy levels (r = 0.668).
Bierry et al.24 investigated the retraction pattern in non-delaminated and delaminated full-thickness RCTs in a study they conducted. According to the results of the study, it was observed that the retraction in the non-delamination group (31.5 mm) was significantly less than the articular surface retraction (36.3 mm) and higher than the bursal surface retraction (21 mm) of the delamination group (p < 0.0001). In the current study, the middle of two retraction levels was determined in patients with delamination and included in the calculations.
This study has some limitations. A limited number of patients have been evaluated. The mechanism of trauma is not specified, which may influence retraction. The other limitation is that the MRI is 1.5 Tesla units. Measurements can be clearer with MRIs with 3 Tesla units. Since MRI scans are performed at 2 mm intervals as standard, better calculations can be made with thinner sections. Due to the retrospective study, these deficiencies can be corrected with a prospective design. To exclude additional subscapularis ruptures and degenerative SS tears that might be missed on MRI, the evaluation of patients who underwent surgical treatment alone was considered the strongest aspect of the study.