Clinical Outcomes of Nonoperative Treatment for Rotator Cuff Retears and Analysis of Factors That Affect Outcomes

Abstract

Background: Patients who sustain a rotator cuff retear after arthroscopic rotator cuff repair are generally considered to have worse clinical outcomes compared with patients with an intact rotator cuff. However, some patients have good clinical outcomes, even with a retorn rotator cuff. Purpose: To report the clinical outcomes of nonoperative treatment for rotator cuff retears and analyze the factors affecting clinical outcomes after a retear. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent arthroscopic rotator cuff repair between 2011 and 2017 were reviewed, and those with a full-thickness retear on postoperative magnetic resonance imaging (MRI) were included in this study. According to their pre- and postoperative scores on the pain visual analog scale (pVAS) and functional visual analog scale (fVAS), the patients were divided into 3 groups: (1) mild group (pVAS ≤ 1 and fVAS ≥ 8), (2) moderate group (pVAS ≤ 1 and fVAS ≤ 7 or pVAS 2-3 and fVAS ≥ 8), and (3) severe group (pVAS ≥ 3 and fVAS ≤ 7). Preoperative data (dominant hand involvement, heavy labor) and tear size on 6-month postoperative MRI were analyzed as factors affecting clinical outcomes. Results: A total of 712 patients were reviewed, and a retear was observed in 62 patients (8.7%). Of the patients with retears, 52 were included in this study: 25 men and 27 women with a mean age of 62.6 years (range, 49-80 years) and mean follow-up period of 40 months (range, 24-88 months). According to the pVAS and fVAS scores, 25 patients (48.1%) were classified into the mild group, 9 (17.3%) into the moderate group, and 18 (34.6%) into the severe group. There were no significant differences in preoperative data among the 3 groups. The tear size in the coronal and sagittal planes decreased by 5.1 and 6.6 mm, respectively, in the mild group but increased by 2.8 and 1.4 mm, respectively, in the severe group. Conclusion: In patients with retears, 48.1% had only mild symptoms at a mean of 40 months postoperatively. Patients with severe symptoms tended to have an increased tear size on postoperative MRI.

A high acromion-greater tuberosity impingement index increases the risk of retear after arthroscopic rotator cuff repair

“…This is consistent with the results of previous studies. 5,32 Although the ATI was positively related to rotator cuff retear, it was not correlated with the clinical outcome. Importantly, this study included a homogeneous population and excluded patients with massive RCTs and severe glenohumeral osteoarthritis.…”

Healthcare costs of failed rotator cuff repairs

“…A recent 2020 study by Shim et al suggests that 51.9% of RCR patients presenting with substantial symptoms and tendon discontinuity following primary surgery will remain moderately to severely symptomatic following the initial nonoperative management. 41 The study by Shim et al also provides evidence that patients with rotator cuff tendon discontinuity on postoperative MRI at 6 months that were larger than their index tear were more likely to have persistent, severe symptoms (pain visual analog scale > 3) after nonoperative management. 41 Additionally, Kim et al identified that younger age, worker’s compensation claim, and lower education level were all patients’ factors that were associated with poorer outcomes after structural failure of RCR.…”

“… 41 The study by Shim et al also provides evidence that patients with rotator cuff tendon discontinuity on postoperative MRI at 6 months that were larger than their index tear were more likely to have persistent, severe symptoms (pain visual analog scale > 3) after nonoperative management. 41 Additionally, Kim et al identified that younger age, worker’s compensation claim, and lower education level were all patients’ factors that were associated with poorer outcomes after structural failure of RCR. 22 Namdari et al performed a retrospective analysis of patients with structural failure of their RCR and found that patients who reported “labor-intensive occupations” represented a defined cohort at high risk for poor outcomes.…”

“…Based on recent peer-reviewed published literature, the average rate of revision surgery (revision RCR or revision to RSA) in patients with structural and clinical failure of their index RCR was 8.1% (Namdari et al, 2 of 28; Shim et al, 4 of 44). 37 , 41 Thus, 9348 (8.3% of 112,172) of primary RCR performed in 2022 are estimated to have failed and underwent subsequent revision RCR or RSA. Furthermore, all patients who underwent a revision operation were assumed to undergo shoulder magnetic resonance imaging (MRI) prior to this surgical intervention.…”

Clinical and Functional Outcomes by Graft Type in Superior Capsular Reconstruction: A Systematic Review and Meta-analysis

“…However, this assumption may not be completely reliable, as patients may have good outcomes even with a retear and other patients may have only mild symptoms. 59 Therefore, it is possible that the rates of retear in some studies may have been affected by less postoperative imaging and thus affected the validity of the meta-analysis. Finally, we did not examine graft fixation methods, as there has been an evolution of anchor type, number, and configuration.…”