Symptomatic Rotator Cuff Tear Progression: Conservatively Treated Full- and Partial-Thickness Tears Continue to...

Area of Science:

• Orthopedics
• Radiology
• Sports Medicine

Background:

• Rotator cuff tears (RCTs) are a common cause of shoulder pain and disability.
• Understanding tear progression is crucial for effective treatment and patient management.
• Previous studies have reported varying rates of RCT progression.

Purpose of the Study:

• To determine the likelihood and risk factors for rotator cuff tear progression in patients with symptomatic partial or full-thickness tears.
• To identify patient factors and MRI findings associated with rotator cuff tear progression.
• To analyze progression in conservatively treated RCTs.

Main Methods:

• Retrospective review of MRI studies from Veteran's Affairs patients with conservatively treated RCTs.
• Tear characteristics measured on MRI at least 1 year apart.
• Progression defined as increase in tear thickness or width/retraction ≥5 mm.

Main Results:

• 61% of RCTs progressed over a mean follow-up of 3.2 years.
• Full-thickness tears (74%) and partial-thickness tears (42%) showed size progression.
• 29% of partial-thickness tears progressed to full-thickness tears.
• Full-thickness tears, anterior rotator cuff cable disruption, subscapularis involvement, tear retraction, and tear width were associated with progression on univariate analysis.
• Full-thickness tears and subscapularis involvement were significant predictors on multivariate analysis.

Conclusions:

• Rotator cuff tears frequently progress in size and severity over time.
• Full-thickness tears and subscapularis involvement are key risk factors for tear progression.
• Observed progression rates were higher than previously reported, particularly in symptomatic patients.