Kuhn, J Bone Joint Surg Am 2024 - The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort
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The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort
Kuhn, Wright, et al.·J Bone Joint Surg Am·2024·24 citations
Kuhn and colleagues asked whether the predictors of surgery after physical therapy for symptomatic, atraumatic full‑thickness cuff tears change over 10 years, and whether the benefit of therapy lasts.
Multicenter prospective MOON cohort of 452 patients enrolled 2007 to 2010, with 355 included in the 10‑year analysis. Funding included an NIH grant and an unrestricted Arthrex gift.
Specific variables from the history, examination and imaging would predict failure of nonoperative treatment.
Key Findings
Over 10 years, 115 of 432 patients (27%) had surgery. Sixty‑five did so within 6 months, and the other 50 at about 5 per year thereafter.
Low expectations of physical therapy were the strongest predictor of surgery within 6 months (HR 16.86, 95% CI 4.94 to 57.59).
After 6 months, expectations mattered less. Workers' Compensation status (HR 3.51, 95% CI 1.44 to 8.58) and activity level (HR 1.79, 95% CI 1.14 to 2.81) were stronger predictors.
Tears retracted to the glenoid were less likely than minimally retracted tears to have early surgery (HR 0.20, 95% CI 0.06 to 0.71). Retraction did not predict later surgery.
With physical therapy, patient‑reported outcomes improved beyond the minimal clinically important difference by 1 year. In patients treated nonoperatively, they did not decline over 10 years.
Only 47% of eligible patients enrolled, 9% died and another 9% were lost. The authors note each may introduce selection bias, and no later MRI tracked tear progression.
Board pearl
Pain intensity and symptom duration did not predict surgery in the covariate‑adjusted models. The authors note both may be associated with tear progression.
Authors' conclusion
Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery, whereas Workers' Compensation status and activity level were predictors of later surgery. Physical therapy was successful in >70% of patients with symptomatic, atraumatic full-thickness rotator cuff tears at 10 years. Outcome measures improved with physical therapy and did not decline over the 10-year follow-up period.
The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort
Kuhn, Wright, et al.·J Bone Joint Surg Am·2024·24 citations
Kuhn and colleagues asked whether the predictors of surgery after physical therapy for symptomatic, atraumatic full‑thickness cuff tears change over 10 years, and whether the benefit of therapy lasts.
Multicenter prospective MOON cohort of 452 patients enrolled 2007 to 2010, with 355 included in the 10‑year analysis. Funding included an NIH grant and an unrestricted Arthrex gift.
Specific variables from the history, examination and imaging would predict failure of nonoperative treatment.
Key Findings
Over 10 years, 115 of 432 patients (27%) had surgery. Sixty‑five did so within 6 months, and the other 50 at about 5 per year thereafter.
Low expectations of physical therapy were the strongest predictor of surgery within 6 months (HR 16.86, 95% CI 4.94 to 57.59).
After 6 months, expectations mattered less. Workers' Compensation status (HR 3.51, 95% CI 1.44 to 8.58) and activity level (HR 1.79, 95% CI 1.14 to 2.81) were stronger predictors.
Tears retracted to the glenoid were less likely than minimally retracted tears to have early surgery (HR 0.20, 95% CI 0.06 to 0.71). Retraction did not predict later surgery.
With physical therapy, patient‑reported outcomes improved beyond the minimal clinically important difference by 1 year. In patients treated nonoperatively, they did not decline over 10 years.
Only 47% of eligible patients enrolled, 9% died and another 9% were lost. The authors note each may introduce selection bias, and no later MRI tracked tear progression.
Board pearl
Pain intensity and symptom duration did not predict surgery in the covariate‑adjusted models. The authors note both may be associated with tear progression.
Authors' conclusion
Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery, whereas Workers' Compensation status and activity level were predictors of later surgery. Physical therapy was successful in >70% of patients with symptomatic, atraumatic full-thickness rotator cuff tears at 10 years. Outcome measures improved with physical therapy and did not decline over the 10-year follow-up period.