This retrospective case series followed patients with acute, traumatic full-thickness rotator cuff tears who chose an initial trial of physical therapy. It asks how often nonoperative treatment fails at mid-term follow-up, and which patient and tear factors predict that failure.
When a healthy patient presents with an acute traumatic full-thickness cuff tear and wants to try therapy first, count the torn tendons. A single-tendon tear (usually isolated supraspinatus) is a reasonable candidate for a physical therapy trial; a multi-tendon tear fails conservative care 81% of the time and should push you toward earlier repair.
Tear size and retraction on MRI did not predict who failed, so do not anchor the decision on those numbers alone. Symptoms often do not track with tear size. Expect failures to declare themselves early. Nearly half the cohort crossed over to surgery within a year, so any nonoperative trial needs close follow-up in that first year.
The reassuring message: delayed repair within one year still produced acceptable outcomes, and no patient progressed to an irreparable tear. That said, this is a small Level IV series without follow-up imaging, so tear progression cannot be excluded.
This retrospective case series followed patients with acute, traumatic full-thickness rotator cuff tears who chose an initial trial of physical therapy. It asks how often nonoperative treatment fails at mid-term follow-up, and which patient and tear factors predict that failure.
When a healthy patient presents with an acute traumatic full-thickness cuff tear and wants to try therapy first, count the torn tendons. A single-tendon tear (usually isolated supraspinatus) is a reasonable candidate for a physical therapy trial; a multi-tendon tear fails conservative care 81% of the time and should push you toward earlier repair.
Tear size and retraction on MRI did not predict who failed, so do not anchor the decision on those numbers alone. Symptoms often do not track with tear size. Expect failures to declare themselves early. Nearly half the cohort crossed over to surgery within a year, so any nonoperative trial needs close follow-up in that first year.
The reassuring message: delayed repair within one year still produced acceptable outcomes, and no patient progressed to an irreparable tear. That said, this is a small Level IV series without follow-up imaging, so tear progression cannot be excluded.