Symptom-to-surgery delay before arthroscopic rotator cuff repair for degenerative tears: a retrospective matched gender-based analysis from the La Tour Group

Anthony Pernoud ; Hugo Bothorel; Alexandre Lädermann

DOI: doi.org/10.70885/hmsj.2026.04.001

Abstract

Background: Degenerative rotator cuff tears are common and can substantially impair quality of life. When conservative management fails, surgical repair is often indicated, and prolonged delays before arthroscopic rotator cuff repair (ARCR) have been associated with tendon degeneration and poorer postoperative outcomes. Although disparities in healthcare access related to gender have been described in other fields, little is known about their influence on surgical timing in rotator cuff disease.Purpose: This study aimed to determine whether the patient-reported delay between the onset of symptoms and surgery differs between men and women undergoing ARCR for degenerative tears.Hypothesis: The hypothesis was that no such differences would be observed.Methods: We conducted a monocentric retrospective matched cohort study of 492 patients (246 men and 246 women) who underwent ARCR for degenerative tears between 2014 and 2025. Patients were matched 1:1 using propensity scores based on age at surgery, preoperative Constant score, Patte classification, and lesion type. The primary outcome was symptom-to-surgery delay. Univariable paired comparisons and multivariable linear regression on log-transformed delay, adjusted for demographics, comorbidities, and preoperative clinical and functional status, were performed. Exponentiated regression coefficients were reported as time ratios, representing multiplicative effects on delay.Results: The mean delay was 27±40 months for men and 24±29 months for women (mean difference: 3 months; 95%CI: -3 to 9; p=0.291). In the multivariable model, women experienced a delay that was estimated to be 15% shorter than men’s (95% CI: -42% to +10%; p=0.224).Conclusion: In this cohort, we found no evidence of gender-related differences in the delay between symptom onset and ARCR for degenerative rotator cuff tears.What is already known on this topic: Delays before arthroscopic rotator cuff repair (ARCR) can worsen tendon quality and outcomes, but the impact of gender on surgical timing remains unclear.What this study adds: This matched cohort study found no significant difference in symptom-to-surgery delay between men and women undergoing ARCR for degenerative tears.How this study might affect research, practice or policy: These results suggest equitable surgical access across genders in this context, supporting standardized criteria and highlighting the need to explore other factors influencing delay.Study design: Retrospective matched cohort study comparing men and women.Level of evidence: Level III; Quality Improvement StudyKeywords: Shoulder; Tendon tear; Female; Equity; Fairness; Privileged and underrepresented groups.https://doi.org/10.70885/hmsj.2026.04.001

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