Rotator Cuff Injury in the Pediatric Population: A Retrospective Review of Patient Characteristics and Treatment at a Single Treatment Center

BACKGROUND: As youth participation in contact and overhead sports has increased in recent decades, so has the occurrence of traumatic and overuse injuries of the shoulder. Rotator cuff injury (RCI) is an infrequent shoulder pathology in pediatric patients and its description in the literature has been scarce leading to management derived largely from adult-based evidence. Greater understanding of RCI characteristics and treatment outcomes in children and adolescents would improve our understanding of this pathology and help to guide clinical decision-making. PURPOSE: To identify pediatric patients with MRI-confirmed RCI treated at a single center in order to summarize injury characteristics, treatment and outcomes. METHODS: A retrospective review of pediatric patients (<18yo) diagnosed with and treated for a RCI between 1/1/2011 and 1/31/2021. Patient demographics, injury mechanism and type, treatment, and outcomes were collected. Descriptive statistics were performed. Bivariate testing was also used to compare operatively and nonoperatively treated cohorts. RESULTS: Fifty-two pediatric patients treated for a rotator cuff avulsion, partial tear, or complete tear were identified. Table 1.1 details injury characteristics, treatment modalities, and patient outcomes overall and each treatment cohort. Mean age was 14.9yo (10-17) and 67% of patients were male. Injuries were most commonly related to participation in the throwing sports (baseball, football, and softball). Operative management was employed in 23% of patients while 77% were managed nonoperatively. Treatment cohorts differed based on tear type with all complete tears being managed operatively (p<0.01). Associated shoulder pathology was common, with the most frequent finding being anterior shoulder instability pathology. One operative patient experienced a retear. Return to play was longer for operatively managed patients (7.1 vs. 4.5 months, p<0.01). CONCLUSION: The present study expands the limited data available regarding RCIs in pediatric patients. Most injuries are associated sports and typically involve the supraspinatus tendon. RCIs are not restricted to skeletally mature patients and are frequently associated with other shoulder pathology. RCIs were associated with good outcomes and low rates of reinjury in patients managed both non-operative and operatively. RCI should be considered in throwing athletes with shoulder pain, even in skeletally immature patients. The optimal treatment strategy for each tear type remains uncertain, but outcomes appear favorable for patients overall.