JBJS will soon publish Evolution of Nonoperatively Treated Symptomatic Isolated Full-Thickness Supraspinatus Tears. This article provides another important contribution to our understanding of the natural history and management of rotator cuff tears.
This Level IV study followed twenty-four patients with isolated full-thickness supraspinatus tears that had been diagnosed by means of magnetic resonance arthrography who were offered rotator cuff repair and elected nonoperative treatment. At a median of forty-two months the mean subjective shoulder score was 74% of that for a normal shoulder and the mean Constant score was 75 points (relative Constant score, 86%). The mean rotator cuff tear size did not change significantly over time. In two shoulders, the tear was no longer detectable on magnetic resonance imaging, in nine shoulders the tear was smaller than it had been at the time of the initial diagnosis, in nine patients the tear had not changed, and in six patients the tear had increased in size. There was a slight but significant progression of fatty muscle infiltration of the supraspinatus, but no patient had fatty infiltration beyond stage 2 at the time of the latest follow-up.
This study reveals that the size of a cuff tear does not necessarily increase with time and that such patients can realize surprisingly high clinical satisfaction.
This Level IV study followed twenty-four patients with isolated full-thickness supraspinatus tears that had been diagnosed by means of magnetic resonance arthrography who were offered rotator cuff repair and elected nonoperative treatment. At a median of forty-two months the mean subjective shoulder score was 74% of that for a normal shoulder and the mean Constant score was 75 points (relative Constant score, 86%). The mean rotator cuff tear size did not change significantly over time. In two shoulders, the tear was no longer detectable on magnetic resonance imaging, in nine shoulders the tear was smaller than it had been at the time of the initial diagnosis, in nine patients the tear had not changed, and in six patients the tear had increased in size. There was a slight but significant progression of fatty muscle infiltration of the supraspinatus, but no patient had fatty infiltration beyond stage 2 at the time of the latest follow-up.
This study reveals that the size of a cuff tear does not necessarily increase with time and that such patients can realize surprisingly high clinical satisfaction.
It is of interest to compare this study with that in a recent post regarding non-operative management of cuff tears, which also indicates that patients can achieve a good outcome without surgery.
This information is consistent with the observations that cuff integrity after cuff repair does not seem to correlate with the clinical result as shown here and here.
In spite of the knowledge, the rate of rotator cuff repair surgery is increasing dramatically.
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