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Outcome of Nonoperative Treatment of Symptomatic Rotator Cuff Tears Monitored by Magnetic Resonance Imaging
Eran Maman, MD1; Craig Harris, MD2; Lawrence White, MD, FRCSC2; George Tomlinson, PhD3; Misra Shashank, MD2; Erin Boynton, MD, FRCSC2
1 Department of Orthopedics “B,” Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, Tel-Aviv 64239, Israel. E-mail address: dremaman@gmail.com
2 Departments of Medical Imaging (C.H. and L.W.) and Orthopedics (M.S. and E.B.), Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada. E-mail address for C. Harris: craignrys@hotmail.com. E-mail address for L. White: lwhite@mtsinai.on.ca. E-mail address for M. Shashank: shashank_surya@hotmail.com. E-mail address for E. Boynton: erin.boynton@rogers.com
3 Department of Medical Imaging, University of Toronto, EN-13 238, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. E-mail address: george.tomlinson@utoronto.ca
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
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Investigation performed at the Orthopedic Department, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Aug 01;91(8):1898-1906. doi: 10.2106/JBJS.G.01335
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Background: Rotator cuff tears are very common, but little is known about the outcome of nonoperative treatment of symptomatic tears in terms of progression and the need for surgical intervention.

Methods: Fifty-nine shoulders in fifty-four patients (thirty-three women and a mean age of 58.8 years) with rotator cuff tears on initial magnetic resonance imaging who had been managed nonoperatively were studied retrospectively. All had magnetic resonance imaging scans acquired six months or more after the initial study. The progression of the rotator cuff tears was associated with age, anatomical and associated parameters, follow-up time, and structural and other magnetic resonance imaging findings.

Results: Baseline magnetic resonance imaging scans demonstrated thirty-three full-thickness tears, twenty-six partial-thickness tears, and four combined full-thickness and partial-thickness tears. Fifty-eight of the fifty-nine tears involved the supraspinatus tendon, and ten involved multiple tendons. Progression in tear size occurred more often among the patients who were followed more than eighteen months (thirteen [48%] of twenty-seven shoulders) compared with those who were followed for less than eighteen months (six [19%] of thirty-two shoulders). Five tears (one partial-thickness tear) decreased in size. More than half (52%; seventeen) of the thirty-three full-thickness tears increased in size compared with 8% (two) of the twenty-six partial-thickness tears (p = 0.0005). Only 17% (six) of the thirty-five tears in patients who were sixty years old or less deteriorated compared with 54% (thirteen) of the twenty-four tears in patients who were more than sixty years old (p = 0.007). No shoulder in a patient with a partial-thickness tear demonstrated supraspinatus atrophy, whereas 24% of those with a full-thickness tear demonstrated atrophy (p = 0.007). The proportion with an increase in tear size was significantly larger for shoulders with fatty infiltration than for those without it (p = 0.0089).

Conclusions: Factors that are associated with progression of a rotator cuff tear are an age of more than sixty years, a full-thickness tear, and fatty infiltration of the rotator cuff muscle(s). In the long-term follow-up of nonoperatively treated rotator cuff tears, magnetic resonance imaging can be used to monitor rotator cuff changes and guide patient management.

Level of Evidence: Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    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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