Progression of Symptomatic Partial-Thickness Rotator Cuff Tears: Association With Initial Tear Involvement and Work Level

Abstract

Background: Partial-thickness rotator cuff tears (PTRCTs) often progress to full-thickness rotator cuff tears (FTRCTs). Thus, it is important to analyze the risk factors for tear progression to determine the proper timing of repair. Purpose: To identify the risk factors associated with progression of PTRCT. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 89 patients diagnosed with PTRCT on magnetic resonance imaging (MRI) scans who underwent nonoperative treatment at the authors’ institution between August 2012 and August 2019. Patient characteristics, shoulder stiffness (compared with the contralateral shoulder); work level (classified as high [heavy manual labor], medium [manual labor with less activity], and low [sedentary activity]); and radiological factors including initial tear size, acromion type (flat, curved, hooked, or heel-shaped), and initial tear involvement (as a percentage of the rotator cuff tendon footprint length) were analyzed to assess their association with tear progression, defined as >20% increase in tear involvement. Results: The mean MRI follow-up period was 22.3 ± 17.2 months (median, 16.1 months; range, 6.4-89.5 months), and tear progression was observed in 12 patients (13.5%). In these 12 patients, tear involvement increased by 60% of the rotator cuff footprint, while mediolateral (ML) and anteroposterior (AP) tear sizes progressed by 1.1 and 1.8 mm, respectively. Univariate regression analysis showed that shoulder stiffness ( P = .031), work level ( P = .001), initial tear involvement ( P < .001), ML and AP tear sizes ( P < .001 and P = .005, respectively), and acromion type ( P = .003) were significantly associated with tear progression. Multivariate regression analysis showed that initial tear involvement (odds ratio [OR], 1.053; 95% CI, 1.006-1.102; P = .026) and high work level (OR, 15.831; 95% CI, 1.150-217.856; P = .039) were independent risk factors for tear progression. The cutoff value for initial tear involvement was 47.5% (sensitivity, 81.8%; specificity, 85.7%). Conclusion: Tear progression was observed in 14% of patients with PTRCT in this study. To predict tear progression, evaluating the tear involvement during initial MRI is essential. The risk of tear progression increased with initial tear involvement >47.5% and a heavy work level.

Percutaneous bone marrow concentrate and platelet products versus exercise therapy for the treatment of rotator cuff tears: a randomized controlled, crossover trial with 2-year follow-up

“…Most patient MRIs (27 of 37) demonstrated evidence of improvement in tear morphology, with some images showing near resolution of their original RC pathology. The natural course expected is progressive enlargement for full-thickness (50% to 82.4%) and partial-thickness tears (13.5% to 26.1%) between 12- and 24-months [ 44 , 55 , 56 ]. Spontaneous improvement or resolution of rotator cuff tears as visualized on MRI is not expected, with low reported rates (4.9% to 11%) [ 44 , 55 , 57 , 58 ].…”

“…The natural course expected is progressive enlargement for full-thickness (50% to 82.4%) and partial-thickness tears (13.5% to 26.1%) between 12- and 24-months [ 44 , 55 , 56 ]. Spontaneous improvement or resolution of rotator cuff tears as visualized on MRI is not expected, with low reported rates (4.9% to 11%) [ 44 , 55 , 57 , 58 ]. While MRI imaging alone has been shown to poorly correlate with clinically relevant pain [ 59 – 61 ], it is encouraging that imaging did tend to improve following BMC treatment.…”

Clinical investigation on the efficacy of modified Mason-Allen in healing delaminated rotator cuff tears

“…Therefore, the major objective of mending a torn rotator cuff is to enhance the patient's quality of life by lowering discomfort and increasing shoulder function. Strati ed rotator cuff tears are a common type of rotator cuff tear and are usually associated with more signi cant pain than full rotator cuff tears [1,2,3], resulting in limited shoulder function and, under the in uence of a variety of risk factors, can lead to an increase in the area of the rotator cuff involved in the tear, which progresses to a full rotator cuff tear [4]. Since Codman proposed the concept of "rotator cuff repair" at the beginning of the 20th century, rotator cuff repair methods have gone through the development of incision repair, arthroscopic-assisted small-incision repair, and total arthroscopic repair [5], and the literature on arthroscopic rotator cuff repair has reported that the probability of rotator cuff retears ranges from 11.4-94% in poor surgical treatment [6,7,8].…”