Structural Fate of Nonoperatively Treated High-Grade Partial-Thickness Rotator Cuff Tears: An Extended Investigation...

Area of Science:

• Orthopedic surgery
• Musculoskeletal imaging
• Biomedical engineering

Background:

• High-grade partial-thickness rotator cuff tears (hPTRCTs) of the supraspinatus tendon are challenging to manage.
• Long-term structural changes in hPTRCTs treated nonoperatively are not well understood.

Purpose of the Study:

• To assess the long-term structural prognosis of nonoperative management for hPTRCTs.
• To determine survival rates and identify risk factors for tear progression in supraspinatus hPTRCTs.

Main Methods:

• Retrospective review of patients with MRI-proven symptomatic supraspinatus hPTRCTs undergoing nonoperative treatment.
• Survival analysis using Kaplan-Meier estimation and Cox proportional hazard models to identify risk factors for tear progression.

Main Results:

• Among 268 patients, 56 (20.9%) experienced tear progression over a mean follow-up of 26 months.
• Median survival time was 79.6 months; 8-year survival rate was 42.1%.
• Initial mediolateral tear size (<62%) and tendinosis grade (2 or 3) were significant predictors of progression.

Conclusions:

• Supraspinatus hPTRCTs demonstrate a time-dependent progression pattern, with increased risk after the first year.
• Smaller mediolateral tear size and intermediate tendinosis grade are associated with higher risk of progression.
• Further research into tear progression mechanisms is needed to optimize treatment strategies.