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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Article info
Publication history
Published online: November 21, 2018
Accepted:
July 12,
2018
Received:
January 9,
2018
Footnotes
See commentary on page 235
The authors report the following potential conflicts of interest or sources of funding: G.M.T. receives support from Smith & Nephew. I.K.Y.L. receives support from Smith & Nephew and Arthrex. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2018 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Progression of Degenerative Full-Thickness Rotator Cuff Tears: Are We Finally Using Natural History Data to Define At-Risk Tears?ArthroscopyVol. 35Issue 1
- PreviewDefining and understanding natural history data for any disease is paramount to developing effective treatment strategies: degenerative rotator cuff disease is no different. The natural history defines disease progression without treatment or intervention. Given the persistent variable indications for surgical intervention for painful rotator cuff tears, a more thorough understanding of the rate of progression of full-thickness rotator cuff tears can help to refine surgical indications and potentially define the risks of nonoperative treatment.
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