Zingg, J Bone Joint Surg Am 2007 - Clinical and Structural Outcomes of Nonoperative Management of Massive Rotator Cuff Tears

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Clinical and Structural Outcomes of Nonoperative Management of Massive Rotator Cuff Tears

Zingg, Gerber, et al.·J Bone Joint Surg Am·2007·283 citations·Retrospective cohort

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Background

The natural history of massive rotator cuff tears is not well known. The purpose of this study was to determine the clinical and structural mid-term outcomes in a series of nonoperatively managed massive rotator cuff tears.

Methods

19 consecutive patients (12 men and 7 women; average age, 64 years) with a massive rotator cuff tear, documented by magnetic resonance imaging, were identified retrospectively.
There were 6 complete tears of 2 rotator cuff tendons and 13 complete tears of 3 rotator cuff tendons.
All patients were managed exclusively with nonoperative means.
Nonoperative management was chosen when a patient had low functional demands and relatively few symptoms and/or if he or she refused to have surgery.
For the purpose of this study, patients were examined clinically and with standard radiographs and magnetic resonance imaging.

Results

After a mean duration of follow-up of 48 months, the mean relative Constant score was 83% and the mean subjective shoulder value was 68%.
The score for pain averaged 11.5 points on a 0 to 15-point visual analogue scale in which 15 points represented no pain.
The active range of motion did not change over time.
Forward flexion and abduction averaged 136 degrees; external rotation, 39 degrees; and internal rotation, 66 degrees.
Glenohumeral osteoarthritis progressed (p = 0.014), the acromiohumeral distance decreased (p = 0.005), the size of the tendon tear increased (p = 0.003), and fatty infiltration increased by approximately one stage in all 3 muscles (p = 0.001).
Patients with a 3-tendon tear showed more progression of osteoarthritis (p = 0.01) than did patients with a 2-tendon tear.
4 of the 8 rotator cuff tears that were graded as reparable at the time of the diagnosis became irreparable at the time of final follow-up.

Conclusions

Patients with a nonoperatively managed, moderately symptomatic massive rotator cuff tear can maintain satisfactory shoulder function for at least four years despite significant progression of degenerative structural joint changes. There is a risk of a reparable tear progressing to an irreparable tear within four years.

Copyright remains with the authors and publisher.

Clinical and Structural Outcomes of Nonoperative Management of Massive Rotator Cuff Tears.

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Clinical and Structural Outcomes of Nonoperative Management of Massive Rotator Cuff Tears

Zingg, Gerber, et al.·J Bone Joint Surg Am·2007·283 citations·Retrospective cohort

|

Background

The natural history of massive rotator cuff tears is not well known. The purpose of this study was to determine the clinical and structural mid-term outcomes in a series of nonoperatively managed massive rotator cuff tears.

Methods

19 consecutive patients (12 men and 7 women; average age, 64 years) with a massive rotator cuff tear, documented by magnetic resonance imaging, were identified retrospectively.
There were 6 complete tears of 2 rotator cuff tendons and 13 complete tears of 3 rotator cuff tendons.
All patients were managed exclusively with nonoperative means.
Nonoperative management was chosen when a patient had low functional demands and relatively few symptoms and/or if he or she refused to have surgery.
For the purpose of this study, patients were examined clinically and with standard radiographs and magnetic resonance imaging.

Results

After a mean duration of follow-up of 48 months, the mean relative Constant score was 83% and the mean subjective shoulder value was 68%.
The score for pain averaged 11.5 points on a 0 to 15-point visual analogue scale in which 15 points represented no pain.
The active range of motion did not change over time.
Forward flexion and abduction averaged 136 degrees; external rotation, 39 degrees; and internal rotation, 66 degrees.
Glenohumeral osteoarthritis progressed (p = 0.014), the acromiohumeral distance decreased (p = 0.005), the size of the tendon tear increased (p = 0.003), and fatty infiltration increased by approximately one stage in all 3 muscles (p = 0.001).
Patients with a 3-tendon tear showed more progression of osteoarthritis (p = 0.01) than did patients with a 2-tendon tear.
4 of the 8 rotator cuff tears that were graded as reparable at the time of the diagnosis became irreparable at the time of final follow-up.

Conclusions

Patients with a nonoperatively managed, moderately symptomatic massive rotator cuff tear can maintain satisfactory shoulder function for at least four years despite significant progression of degenerative structural joint changes. There is a risk of a reparable tear progressing to an irreparable tear within four years.

Copyright remains with the authors and publisher.

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