Factors associated with choice for surgery in newly symptomatic degenerative rotator cuff tears: a prospective cohort evaluation

Jay D. Keener, Alexander W. Aleem, Aaron M. Chamberlain, Julianne Sefko, Karen Steger-May

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The patient-related factors for the perceived need for surgery for degenerative rotator cuff tears are not known. The purpose of this study is to examine patient- and tear-specific factors leading to surgery in newly painful degenerative rotator cuff tears. Methods: Asymptomatic, degenerative rotator cuff tears were followed prospectively to identify the onset of pain and tear enlargement. Newly painful tears were continually monitored with a focus on identifying patient-specific (age, occupation, activity level) and tear-specific (tear type and size, tear progression, American Shoulder and Elbow Surgeons score, muscle degeneration) factors that are associated with surgical intervention. Results: Forty-eight of 169 newly painful shoulders were eventually managed surgically. Factors associated with surgical treatment included younger age (P = .0004), pain development earlier in surveillance (P = .0002), a greater increase in pain (P = .0001), a decline in American Shoulder and Elbow Surgeons score (P < .0001), and a history of contralateral shoulder surgery (P = .0006). Eighty-five of the 169 tears (50%) enlarged either before or within 2 years of pain development. Neither tear type (P = .13), tear enlargement (P = .67) nor tear size (P = .51) was associated with surgery. Neither the severity of muscle degeneration, occupational status, hand dominance, Shoulder Activity Score, nor changes in RAND-12 mental or physical scales differed between groups. Discussion: For newly painful rotator cuff tears, patient-specific factors such as younger age and prior surgery on the contralateral shoulder are more predictive of future surgery than tear-specific factors or changes in tear size over time.

Original languageEnglish
Pages (from-to)12-19
Number of pages8
JournalJournal of Shoulder and Elbow Surgery
Volume29
Issue number1
DOIs
StatePublished - Jan 2020

Keywords

  • Level I
  • Prognosis Study
  • Prospective Design
  • Rotator cuff tear
  • degenerative
  • operative treatment
  • predictor
  • prospective
  • surgery

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