Clinical stability despite progressive fatty infiltration in patients over 50 years old with full-thickness rotator...

Management of patients over 50 years old with a rotator cuff tear (RCT), remains complex and individually driven. We assessed long-term clinical and radiological outcomes under conservative treatment and searched for any feature that would better define medical strategy.

A prospective multicentric cohort. Ten participating tertiary level centers. We included 127 patients, aged 50 to 75, with a symptomatic RCT confirmed by MRI and not warranting surgical repair on the short term, according to current practice recommendations. 104 of them (82% retention rate) were evaluated at 2-year follow-up visit. Among those 104 patients, 78 agreed to participate in an extension phase until 5-year final follow-up and 75 of them were evaluated at this time-point. The principal objective was to determine clinical outcome 2 years following diagnosis, using Constant score. Secondary objectives were to evaluate clinical outcomes at 5-year follow-up and radiological outcomes, centrally assessed by MRI, at baseline, 2 and 5-year follow-up visits.

Among the 104 patients that remained in follow-up at 2 years, 8 had shoulder surgery and 8 reported a worsening clinical evolution at M24. Only 4 of the 78 enrolled in the extension phase had worsening of Constant score at 5-year follow-up visit. MRI evaluation was carried out in 94 patients at 2-year and 70 at 5-year follow-up. Among them, 70% at 2-year and 60% at 5-year follow-up evaluation had no radiological worsening of their RCT, compared to baseline. We also observed a significant degradation of muscle status, including atrophy or fatty infiltration, in 54.3% of patients at 2-year and 71.4% at 5-year follow-up. No correlation was found between Constant score and this structural muscle evolution.

Patients with RCT had a favorable clinical outcome under conservative treatment, while a majority of RCT remained stable in those who remained in a 5-year follow-up. However, progression of fatty muscle infiltration seems an inexorable process, independent of clinical evolution.

NCT02510352.