title: Time to surgery in acute rotator cufftear: A systematic review.
abstract: OBJECTIVE
  We performed a systematic review of the literature to determine whether earlier surgical repair of acute rotator cuff tear (ARCT) leads to superior post-operative clinical outcomes.
  
  
  METHODS
  The MEDLINE, Embase, CINAHL, Web of Science, Cochrane Libraries, controlled-trials.com and clinicaltrials.gov databases were searched using the terms: 'rotator cuff', or 'supraspinatus', or 'infraspinatus', or 'teres minor', or 'subscapularis' AND 'surgery' or 'repair'. This gave a total of 15 833 articles. After deletion of duplicates and the review of abstracts and full texts by two independent assessors, 15 studies reporting time to surgery for ARCT repair were included. Studies were grouped based on time to surgery < 3 months (group A, seven studies), or > 3 months (group B, eight studies). Weighted means were calculated and compared using Student's t-test.
  
  
  RESULTS
  Group B had a significantly higher pre-operative Constant score (CS) (p < 0.001), range of movement in external rotation (p = 0.003) and abduction (p < 0.001) compared with group A. Both groups showed clinical improvement with surgical repair; group A had a significantly improved Constant score, University of California, Los Angeles (UCLA) shoulder score, abduction and elevation post-operatively (all p < 0.001). Group B had significantly improved Constant score (p < 0.001) and external rotation (p < 0.001) post-operatively. The mean Constant score improved by 33.5 for group A and by 27.5 for group B.
  
  
  CONCLUSIONS
  These findings should be interpreted with caution due to limitations and bias inherent to case-series. We suggest a trend that earlier time to surgery may be linked to better Constant score, and active range of movement in abduction and elevation. Additional prospective studies are required.
authors.affiliation: University of Toronto, Facultyof Medicine, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Mukovozov
authors.forename: S
authors.initials: S
authors.lastname: Byun
authors.forename: F
authors.initials: F
authors.lastname: Farrokhyar
authors.forename: I
authors.initials: I
authors.lastname: Wong
keywords: Acute rotator cuff tear; Acute tear; Infraspinatus; Repair; Rotator cuff; Subscapularis; Supraspinatus; Surgery; Systematic review; Teres minor; Time to surgery