Yang-Soo Kim1, Sung-Eun Kim2, Sung-Ho Bae1, Hyo-Jin Lee1, Won-Hee Jee3, Chang Kyun Park1. 1. Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea. 2. Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea. 4kingdom@naver.com. 3. Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Abstract
PURPOSE: The purpose of this study was to analyse the natural course of symptomatic full-thickness and partial-thickness rotator cuff tears treated non-operatively and to identify risk factors affecting tear enlargement. METHODS: One hundred and twenty-two patients who received non-surgical treatment for a partial- or full-thickness supraspinatus tear were included in this study. All rotator cuff tears were diagnosed with magnetic resonance imaging (MRI), and the same modality was used for follow-up studies. Follow-up MRI was performed after at least a 6-month interval. We evaluated the correlation between tear enlargement and follow-up duration. Eleven risk factors were analysed by both univariate and multivariate analyses to identify factors that affect enlargement of rotator cuff tears. The mean follow-up period was 24.4 ± 19.5 months. RESULTS: Out of 122 patients, 34 (27.9%) patients had an initial full-thickness tear and 88 (72.1%) patients had a partial-thickness tear. Considering all patients together, tear size increased in 51/122 (41.8%) patients, was unchanged in 65/122 (53.3%) patients, and decreased in 6/122 (4.9%) patients. Tear size increased for 28/34 (82.4%) patients with full-thickness tears and 23/88 (26.1%) patients with partial-thickness tears. From the two groups which were followed over 12 months, a higher rate of enlargement was observed in full-thickness tears than in partial-thickness tears (6-12 months, n.s.; 12-24 months, P = 0.002; over 24 months, P < 0.001). Logistic regression revealed that having a full-thickness tear was the most reliable risk factor for tear progression (P < 0.001). CONCLUSIONS: This study found that 28/34 (82.4%) of symptomatic full-thickness rotator cuff tears and 23/88 (26.1%) of symptomatic partial-thickness tears increased in size over a follow-up period of 6-100 months. Full-thickness tears showed a higher rate of enlargement than partial-thickness tears regardless of the follow-up duration. Univariate and multivariate analyses suggested that full-thickness tear was the most reliable risk factor for tear enlargement. The clinical relevance of these observations is that full-thickness rotator cuff tears treated conservatively should be monitored more carefully for progression than partial-thickness tears. LEVEL OF EVIDENCE: IV.
PURPOSE: The purpose of this study was to analyse the natural course of symptomatic full-thickness and partial-thickness rotator cuff tears treated non-operatively and to identify risk factors affecting tear enlargement. METHODS: One hundred and twenty-two patients who received non-surgical treatment for a partial- or full-thickness supraspinatus tear were included in this study. All rotator cuff tears were diagnosed with magnetic resonance imaging (MRI), and the same modality was used for follow-up studies. Follow-up MRI was performed after at least a 6-month interval. We evaluated the correlation between tear enlargement and follow-up duration. Eleven risk factors were analysed by both univariate and multivariate analyses to identify factors that affect enlargement of rotator cuff tears. The mean follow-up period was 24.4 ± 19.5 months. RESULTS: Out of 122 patients, 34 (27.9%) patients had an initial full-thickness tear and 88 (72.1%) patients had a partial-thickness tear. Considering all patients together, tear size increased in 51/122 (41.8%) patients, was unchanged in 65/122 (53.3%) patients, and decreased in 6/122 (4.9%) patients. Tear size increased for 28/34 (82.4%) patients with full-thickness tears and 23/88 (26.1%) patients with partial-thickness tears. From the two groups which were followed over 12 months, a higher rate of enlargement was observed in full-thickness tears than in partial-thickness tears (6-12 months, n.s.; 12-24 months, P = 0.002; over 24 months, P < 0.001). Logistic regression revealed that having a full-thickness tear was the most reliable risk factor for tear progression (P < 0.001). CONCLUSIONS: This study found that 28/34 (82.4%) of symptomatic full-thickness rotator cuff tears and 23/88 (26.1%) of symptomatic partial-thickness tears increased in size over a follow-up period of 6-100 months. Full-thickness tears showed a higher rate of enlargement than partial-thickness tears regardless of the follow-up duration. Univariate and multivariate analyses suggested that full-thickness tear was the most reliable risk factor for tear enlargement. The clinical relevance of these observations is that full-thickness rotator cuff tears treated conservatively should be monitored more carefully for progression than partial-thickness tears. LEVEL OF EVIDENCE: IV.
Authors: Stephen Fealy; Ernest W April; Michael Khazzam; Juan Armengol-Barallat; Louis U Bigliani Journal: J Shoulder Elbow Surg Date: 2005 Sep-Oct Impact factor: 3.019
Authors: Jay D Keener; Leesa M Galatz; Sharlene A Teefey; William D Middleton; Karen Steger-May; Georgia Stobbs-Cucchi; Rebecca Patton; Ken Yamaguchi Journal: J Bone Joint Surg Am Date: 2015-01-21 Impact factor: 5.284
Authors: Eran Maman; Craig Harris; Lawrence White; George Tomlinson; Misra Shashank; Erin Boynton Journal: J Bone Joint Surg Am Date: 2009-08 Impact factor: 5.284
Authors: A A Narvani; M A Imam; A Godenèche; E Calvo; S Corbett; A L Wallace; E Itoi Journal: Ann R Coll Surg Engl Date: 2020-01-03 Impact factor: 1.891
Authors: Ian K Lo; Matthew R Denkers; Kristie D More; Atiba A Nelson; Gail M Thornton; Richard S Boorman Journal: Open Access J Sports Med Date: 2018-09-18
Authors: Avinesh Agarwalla; Gregory L Cvetanovich; Anirudh K Gowd; Anthony A Romeo; Brian J Cole; Nikhil N Verma; Brian Forsythe Journal: Orthop J Sports Med Date: 2019-05-28
Authors: Andrew T Pennock; Jerry Dwek; Emily Levy; Philip Stearns; John Manning; M Morgan Dennis; Amanda Davis-Juarez; Tracey Bastrom; Kenneth S Taylor Journal: Orthop J Sports Med Date: 2018-02-23