EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: EARLY VERSUS LATE REPAIR FOR TRAUMATIC ROTATOR CUFF TEARS

Abstract

ABSTRACT Introduction: Traumatic rotator cuff tears are acute structural injuries to one or more rotator cuff tendons caused by an identifiable trauma, generally associated with the abrupt onset of pain, weakness, and shoulder dysfunction. They must be distinguished from chronic degenerative tears and from acute injuries superimposed on previously degenerated tendons. The optimal timing of surgical repair remains debated. Methods: A systematic review was conducted in PubMed, Embase, Cochrane Library, and the Virtual Health Library (VHL) up to March 2026 to evaluate whether early repair is more effective than late repair for the treatment of traumatic rotator cuff tears, with respect to clinical and functional outcomes, retear, and return to pre-injury activities. The certainty of evidence was assessed with the GRADE approach. Results: Three cohort studies were included. The definition of "early" repair is not standardized in the literature – some authors consider it up to 3 weeks and others up to 6 months – so studies defining "early" as up to 3–4 months were included, which represents a potential source of bias. Functional outcomes were similar between early and late repair, whereas early repair was associated with and a lower likelihood of requiring tendon grafting in larger tears. The certainty of evidence was very low. Conclusion: The surgeon should individually assess patient- and disease-related characteristics to make the best treatment decision. Given the risk of irreparability and longer rehabilitation, the project recommends that, after a traumatic tear, repair be performed as early as possible. Level of evidence II; Systematic review.