Predictors of failure after conservative treatment of symptomatic partial-thickness rotator cuff tear

Abstract

Further studies are required to determine the effectiveness of conservative treatment of partial-thickness rotator cuff tear(PTRCT). Here, we aim to identify the predictors of failure after conservative treatment in a large series of patients with symptomatic PTRCT. The outcome of conservative treatment in a retrospective cohort of 272 patients with symptomatic PTRCT was evaluated. Demographic, clinical, and radiographic characteristics were extracted from the patients' medical records. Subjective assessments included Constant Shoulder Score (CSS), visual analog scale for pain (VAS pain), activities of daily living (ADL) score, and American Shoulder and Elbow Surgeons (ASES) score, all performed at the first visit. The association of treatment failure with the patient/tear characteristics was assessed. The bursal-type PTRCT was associated with male gender (P = .02), earlier referral of the patients (P= .001), more nonsteroidal anti-inflammatory drug consumption (P = .004), more positive painful arc syndrome (P = .006), and lower CSS (P < .001). These symptoms subsided completely or considerably in 172 (63.2%) patients after the conservative treatment, from which the disease relapsed in 21 (12.2%) patients at the mean follow-up of 22.2 ± 8.8 months. The symptoms led to surgery in the remaining 100 (36.8%) patients. The failure rate of conservative treatment was significantly higher in the dominant injuries (P = .015), the bursal type (P < .001), and tears involving more than 50% of the depth of the tendon (P < .001). The bursal type tear, dominant tears, and tears involving >50% of the tendon depth are factors capable of predicting failure after conservative management of PTRCT.