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Full-Thickness Rotator Cuff Tears: What Is the Rate of Tear Progression? A Systematic Review

Published:November 21, 2018DOI:https://doi.org/10.1016/j.arthro.2018.07.031

      Purpose

      To systematically review the literature and determine the rate of radiographic tear progression of nonoperatively treated full-thickness rotator cuff tears.

      Methods

      The PubMed, Embase, and Cochrane Library databases were systematically reviewed to identify all articles related to nonoperatively treated rotator cuff tears. English-language studies of Level I through IV evidence examining chronic, full-thickness rotator cuff tears in adults were included. Partial-thickness tears were excluded. Rotator cuff tears were analyzed according to the presence or absence of symptoms. The primary outcome was radiographic tear progression defined as an increase in tear size of 5 mm or greater on magnetic resonance imaging or ultrasound.

      Results

      Eight studies were included for statistical analysis, and 411 tears were analyzed for progression. No difference in the rate of tear progression was detected between the asymptomatic and symptomatic groups (40.6% at 46.8 months and 34.1% at 37.8 months, respectively; P = .65). Calculation of the number needed to treat showed that for an 8% retear rate at 2-year follow-up, approximately 7 patients with rotator cuff tears would have to undergo operative repair to prevent 1 tear from progressing radiographically.

      Conclusions

      This study showed that with the data available, asymptomatic and symptomatic rotator cuff tears carry similar rates of tear progression over time. Most of these tears will not progress significantly over short- to intermediate-term follow-up.

      Level of Evidence

      Level IV, systematic review of Level I through IV evidence.
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