ShoulderWhat happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears
Section snippets
Materials and methods
Patients with chronic (>3 months), full-thickness rotator cuff tears (demonstrated on ultrasound or magnetic resonance imaging) who were referred consecutively to 1 of 2 senior shoulder surgeons were enrolled in this prospective cohort study between October 2008 and September 2010.
The inclusion criteria were as follows:
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Age of 40 to 85 years
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Full-thickness tear of supraspinatus or infraspinatus, confirmed on ultrasound or magnetic resonance imaging
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Symptomatic for a minimum of 3 months
The
Results
A total of 116 patients were originally screened prospectively, of whom 104 met the inclusion criteria and provided informed consent for participation (Fig. 1). Of the 104 patients enrolled, 2 subsequently applied for workers' compensation while 9 were lost to follow-up and had insufficient data for 2-year analysis. Thus, 93 patients from the original cohort were analyzed. Demographic data are provided in Table I.
At 5 or more years, all 93 patients were again contacted for follow-up. Of these
Discussion
Despite the extensive controversy in the current orthopedic literature surrounding the optimal treatment of chronic, full-thickness rotator cuff tears, the results of this study show that nonoperative management is a reasonable treatment option that can provide lasting relief over the medium term. It would be our inference that successfully treated patients are relatively asymptomatic and most often remain that way over time. The results demonstrate durability over time. It should be emphasized
Conclusion
Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. Patients who subsequently ended up requiring surgical repair had similar outcomes to those who underwent surgery early in the study, as well as those in whom nonoperative treatment was successful. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time, no matter whether
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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2023, Journal of Orthopaedic ScienceCitation Excerpt :Nonsurgical treatment of symptomatic full-thickness rotator cuff tears is reported to be successful in approximately 73%–80% of patients [1–8].
An Evidence-Based Approach to Orthobiologics for Tendon Disorders
2023, Physical Medicine and Rehabilitation Clinics of North AmericaCitation Excerpt :Unfortunately, there is a growing body of literature dating back to 1977 when the first meta-analysis on CCS was performed, demonstrating detrimental effects on soft tissues, including tendon rupture.17 Furthermore, surgery for repair of complete rotator cuff tears does not seem to improve quality of life compared with nonoperative treatments.18 Recent randomized controlled studies show no difference in long-term outcomes between nonoperative and operative interventions in the management of rotator cuff disease.19,20
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This study was approved by the Conjoint Health Research Ethics Board, Faculty of Medicine, University of Calgary (study ID E-21979).