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Clinical and Structural Outcome of Conservatively Treated Massive Rotator Cuff Tears

Authors: Patrick Oliver Zingg

References: Presented AAOS 2005

Abstract
Conservative treatment of massive rotator cuff tears yields good clinical results, despite significant progression of degenerative changes.

The purpose of the study was to determine natural history of massive rotator cuff tears. Massive tears were defined as disinsertation of at least two complete rotator cuff tendons.

Between 1996 and 1998 nineteen patients (twelve men, seven women; average age: sixty-four years) with massive rotator cuff tears (six two-tendon, thirteen three-tendon tears) documented with MRI who have not undergone an operation were retrospectively reviewed. The decision for non-operative treatment was made in oligosymptomatic patients with moderate functional demands or if shoulder function did not justify surgical treatment. The patients were reviewed clinically, with standard x-rays and with MRI.

After an average follow-up of 48 months the mean relative Constant score was 83% and the subjective shoulder value 68%. Pain averaged 11.5 points at the visual analog scale, active forward flexion and abduction 136°, and abduction strength 3 kg. Radiographically glenohumeral osteoarthritis progressed (p=0.014) and the acromiohumeral distance decreased (p=0.005). The size of the rupture progressed (p=0.003). Fatty muscle degeneration increased approximately one stage in all three tendons: supraspinatus (p<0.001), infraspinatus (p=0.001) and subscapularis (p<0.001). Patients with three-tendon tears showed a stronger progression of osteoarthritis (p=0.01). Out of the 8 cuff tears classified as reparable at the time of diagnosis 4 became irreparable.

The relatively good clinical and functional results can be maintained, but degenerative structural changes show a significant progression.

Younger oligosymptomatic patients with reparable tears should be informed about the risk of 50% of deterioration from reparable to irreparable tears within 4 years.

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