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Scientific Articles   |    
Evolution of Nonoperatively Treated Symptomatic Isolated Full-Thickness Supraspinatus Tears
Sandro F. Fucentese, MD1; Andreas L. von Roll, MD1; Christian W.A. Pfirrmann, MD1; Christian Gerber, MD1; Bernhard Jost, MD1
1 Department of Orthopedics (S.F.F., A.L.V.R., C.G., B.J.) and Division of Radiology (C.W.A.P.), University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. E-mail address for B. Jost: bernhard.jost@kssg.ch
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Investigation performed at the Department of Orthopedics and Division of Radiology, University Hospital Balgrist, Zurich, Switzerland

A commentary by Robert Z. Tashjian, MD, is linked to the online version of this article at jbjs.org.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 May 02;94(9):801-808. doi: 10.2106/JBJS.I.01286
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Abstract

Background: 

The natural history of small, symptomatic rotator cuff tears is currently unclear. The purpose of the present study was to assess the clinical and structural outcomes for a consecutive series of patients with symptomatic, isolated full-thickness supraspinatus tears who had been offered rotator cuff repair but declined operative treatment.

Methods: 

In the study period, twenty-four patients with isolated full-thickness supraspinatus tears that had been diagnosed by means of magnetic resonance arthrography were offered rotator cuff repair and elected nonoperative treatment. The twenty men and four women had an average age of fifty-two years at the time of diagnosis. At a median of forty-two months after the diagnosis, all patients were reexamined clinically according to the Constant and Murley scoring system and all shoulders underwent standard magnetic resonance imaging.

Results: 

At the time of follow-up, the mean subjective shoulder score was 74% of that for a normal shoulder and the mean Constant score was 75 points (relative Constant score, 86%). The mean rotator cuff tear size did not change significantly over time (95% confidence interval, 0.51 to 1.12). In two shoulders, the tear was no longer detectable on magnetic resonance imaging, in nine shoulders the tear was smaller than it had been at the time of the initial diagnosis, in nine patients the tear had not changed, and in six patients the tear had increased in size. There was a slight but significant progression of fatty muscle infiltration of the supraspinatus, but no patient had fatty infiltration beyond stage 2 at the time of the latest follow-up (95% confidence interval, 0% to 14%).

Conclusions: 

In a consecutive series of patients who had been offered repair of an isolated, symptomatic supraspinatus tear, the refusal of operative treatment resulted in surprisingly high clinical patient satisfaction and no increase of the average size of the rotator cuff tear 3.5 years after the recommendation of operative repair. This study confirms that the size of small rotator cuff tears does not invariably increase over a limited period of time. Distinguishing tears that will increase in size from those that will not needs further study.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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