Tear Progression of Symptomatic Full-Thickness and Partial-Thickness Rotator Cuff Tears as Measured by Repeated MRI

Abstract

calcaneus and talus. There was significantly more inversion in the subtalar joint than the tibiotalar joint with weight-bearing inversion. Conclusion: We found that with weight-bearing inversion of the ankle joint complex, there was significantly lower stiffness and torque following injury to both the ATFL and CFL, and sequentially greater inversion of the talus and calcaneus with progressive ligament injury. This corresponds to a shift in the COF in the tibiotalar joint and a reduction of peak pressure. The CFL contributes considerably to lateral ankle stability, and higher-grade sprains that include CFL injury appear to result in substantial alteration of contact mechanics at the ankle joint. Thus, repair of the CFL should be considered during lateral ligament reconstruction, and there may be a role for early repair in high grade injuries to avoid the intermediate and long-term consequences (e.g., articular damage or tendon injury) of a loose or incompetent CFL.

When Should We Repair Partial-Thickness Rotator Cuff Tears? Outcome Comparison Between Immediate Surgical Repair Versus Delayed Repair After 6-Month Period of Nonsurgical Treatment

“…In previous studies, the majority of rotator cuff tears remain unchanged without an increase in tear size, despite no evidence of selfhealing in rotator cuff tears. 5,14 Considering the natural history of PTRCTs and the result of this study, a trial period of nonoperative care of PTRCTs seems reasonable, rather than prompt surgical repair. This will not only help with pain control but may also help avoid unnecessary surgical intervention for asymptomatic PTRCTs.…”

“…9 Furthermore, there is no clear clinical or biological evidence that nonoperative treatment will lead to actual healing of the tendon. 5,14 Practically, the problem regarding the nonoperative treatment of PTRCTs is the absence of clear indications for when surgical repair should be performed. There is no doubt that surgical intervention for PTRCT is necessary in the case of tear progression with accompanying discomfort/pain or functional disability.…”

“…Although the natural history of PTRCTs is unclear, there is a clear consensus that no spontaneous healing occurs without surgical treatment. 5,14 Thus, the goal of the nonoperative treatment of PTRCTs is to maintain a symptom-free or tolerable state, particularly in the short term, not to recover actual tendon integrity. As there is no evidence of actual recovery of tendon with nonoperative treatment and there is no consensus on the optimal duration or endpoint of nonoperative treatment before operative treatment, surgeons have difficulties in establishing treatment algorithms for symptomatic PTRCTs.…”

Complete Rotator Cuff Tear: An Evidence-Based Conservative Management Approach

“…A recent study by Yang-Soo et al [34] found that 28 of 34 patients (82.4%) with symptomatic FTTs and 23 of 88 patients (26.1%) with symptomatic PTTs had tears that increased in size over a follow-up period of 6 months to 8 years. The clinical relevance of these observations is that FTTs treated conservatively should be monitored more carefully than PTTs for progression.…”

The enigma of rotator cuff tears and the case for uncertainty

“…Some tears do increase in size, with greatest rate of increase in those with full-thickness tears; observed in 82% versus 26% of those with partial-thickness tears 8. But it is also apparent that many RC tears do not progress over time, and, importantly, these increases are not consistently associated with poorer outcomes of pain and function 8…”