Good morning, my name is Stephanie Bowden. I'm an orthopedic surgery resident at UPMC in Pittsburgh. I'd like to thank my co-authors and AOSSM for allowing us to present our work. We have no relevant disclosures. Symptomatic rotator cuff tears are a common cause of shoulder pain and disability and can be generally classified as traumatic or atraumatic in nature. Atraumatic tears generally are thought to occur due to age-related tendon degeneration with subsequent progression from tendinopathy to partial and full thickness tears. While traumatic tears generally occur in younger patients after a fall or trauma to an abducted and externally rotated arm. While tear size, number of tendons involved, tear chronicity, fatty infiltration and muscle atrophy have been investigated of significant predictors of functional outcome and repair integrity after rotator cuff repairs. There's no clear data on the role that tear etiology may play in predicting functional outcomes after rotator cuff repairs. The purpose of our study was to determine if repairs of traumatic rotator cuff tears differ in their functional and clinical outcomes compared to their atraumatic counterparts. So we performed a retrospective review of all rotator cuff repairs performed at our institution between 2013 and 2018 by fellowship trained sports medicine surgeons. We included all patients who had documentation of presence or absence of a traumatic etiology, preoperative MRI available for review and clinical follow-up of at least two years. Revision rotator cuff repairs were excluded. Traumatic tears were defined as those with a specific trauma related to the onset of correlating symptoms with an adequate injury mechanism and confirmed to be the presence of muscular edema on MRI. Basic demographic data, pre- and postoperative patient reported outcome measures and postoperative complications were obtained via chart review. 221 patients met inclusion criteria. Average follow-up was 27 months. 33% of patients had traumatic tears and 67% had atraumatic tears. Patients with traumatic rotator cuff tears were more often male and involved their non-dominant arm. There were no significant differences between the two cohorts with regard to age or other demographic variables. On average, those with traumatic rotator cuff tears sought care quicker after onset of symptoms, 6-1-1 versus 18 months compared to those with atraumatic tears. And time from presentation to surgery was also significantly faster in those with traumatic tears. Preoperative imaging revealed no significant differences with regard to Goutelier classification, critical shoulder angle, average hematoclassification or presence of osteoarthritis. There was also no significant difference in the number or combination of tendons repaired between the two cohorts. Preoperatively, patients with traumatic rotator cuff tears had significantly less forward flexion and were weaker with forward flexion and internal rotation. There were no significant differences in preop scores, except for lower PROMIS-10 physical scores in the traumatic cohort. Postoperatively, there were no differences in any of the assessed outcomes between the two cohorts, except for forward flexion, which was significantly greater in the traumatic cohort. Both cohorts saw significant improvements in VAS and SSV scores, as well as forward flexion and external rotation strength. However, only those with traumatic tears saw significant improvements in PROMIS-10 physical ASES scores and forward flexion motion. The traumatic rotator cuff tear cohort had greater improvements in SSV, forward flexion motion, and strength to forward flexion, internal and external rotation compared to their atraumatic counterparts. There were no significant differences in postoperative complications of re-tear, need for revision rotator cuff repair, postoperative stiffness, need for manipulation under anesthesia, infection or conversion to reverse total shoulder arthroplasty. Few studies have directly compared outcomes after rotator cuff repair based on tear etiology. And those that have have been limited by small sample size, confounding variables, and lack of preoperative imaging. Our study corroborates the results of Braun et al. with improved outcomes after repair in the traumatic compared to atraumatic cuff tears. And it's the first to suggest that such improvements persist even with older patients. The improved functional results after cuff repair and traumatic tears in our study may be in part attributable to the faster time to surgery in combination with the likely improved biological healing environment in the more acute phase of injury. The major finding in our study was that patients with traumatic rotator cuff tears experienced greater improvements in range of motion, shoulder strength, and perceived shoulder function compared to those with atraumatic tears at a minimum of two years follow-up. This information can help guide discussions about expectations and functional outcomes in patients preoperatively based on tear etiology and can be used in conjunction with other preoperative predictors to provide a more comprehensive understanding of surgical outcomes. Future directions, so future studies should investigate if these improvements are clinically significant and if timing of repair impacts outcomes of atraumatic cuff tears. Thank you.

rotator cuff tears

traumatic tears

atraumatic tears

functional outcomes

surgical outcomes