Outcomes of initial nonoperative treatment of traumatic full-thickness rotator cuff tears

Abstract

IntroductionNon-surgical management of chronic, degenerative rotator cuff tears (RCT) can be an effective treatment strategy, but there is limited evidence to support conservative treatment for acute, traumatic RCTs. The objective of this study is to assess clinical outcomes and predictors of treatment success for patients with traumatic RCTs who elected for initial non-operative treatment. MethodsPatients from a single institution were retrospectively identified using diagnostic codes for traumatic RCT followed by confirmed initial treatment with at least 2 months of physical therapy. Exclusion criteria included surgery within 2 months of injury and greater than grade I fatty infiltration on MRI. At minimum 2-year follow-up, patients were contacted by phone to collect interval surgical history and standardized patient reported outcomes. All those who had surgical treatment and those with satisfaction ratings of “moderately dissatisfied” and “very dissatisfied” were considered to have failed physical therapy. ResultsFollow-up outcomes were obtained in forty of 49 patients (82%) with an average follow-up time of 4.2 years. Nine RCTs (22%) were small (< 1cm), 22 (54%) were medium (>1 and < 3cm), and 9 (22%) were large (> 3 cm and < 5cm). Grade I fatty infiltration was seen on 25% (n=10) of MRIs. Eighteen patients (45%) underwent rotator cuff repair following an average 6 months (R: 3-12) of nonoperative treatment. In total, 23 of 40 patients (58%) were determined to have failed nonoperative treatment. Patients with multiple tendons torn were more likely to fail conservative management (p=0.014). Tear size and retraction were not significantly different between patents who had surgery and those who did not. Patients who underwent surgical management had 83% satisfaction rate at final follow-up compared to 55% satisfaction for patients who had no surgery (p=0.054). There was no statistical difference in the ASES (American Shoulder and Elbow Surgeons score) and VAS (Visual Analog Scale) between these groups. While patients who had surgery had a higher mean SANE (Single Alpha Numeric Evaluation) (86.3 vs. 75.1; p=0.041), this difference was below the previously established minimally clinically important difference. ConclusionNon-operative treatment remains a viable option for certain patients with traumatic RCTs; however, the results of our study demonstrate a considerable early failure rate. This study further supports historical literature demonstrating reliably successful outcomes with surgical treatment of acute, traumatic RCTs. Level of EvidenceLevel IV; Case Series; Treatment Study