Partial thickness tears of the supraspinatus tendon
A prospective study was performed to evaluate the structural progression of high grade partial thickness rotator cuff tears (hPTRCT) managed non-operatively.
Investigations were set to affirm the widely held impression of the natural progression of these injuries toward a full thickness tear, lending support to early surgical intervention.
The authors conclude that due to the timelines used in the investigation, long term outcomes are still unknown. However, a relative minority of the subjects reviewed after minimum 1 year follow-up showed progression of tears under MRI.
A cohort of both of men and women with an average age of 62 years was analysed at initial assesssment and again at follow-up with the use of MRI for purposes of tracking tear progression.
The authors subclassified groups into 3 categories:
- A decrease in tear >20% change, equated to improved;
- < 20% increase/ decrease defined as no change;
- > 20% increase in tear represented progression of status.
Results of this study revealed that only 16% of subjects progressed in tear depth. The unchanged group represented 59% subjects and 25% of those with hPTRCT showed improvement, 12% of which even demonstrated full healing.
The authors also confirmed that the presence of intial tendinosis was associated tear progression further supporting previous studies which defined this as an important prognostic factor in healing for repairs.
Although surgical intervention has been indicated for the prevention of tear progression to full thickness tears, possible retraction and/ or fatty degeneration, current evidence supports the nonoperative management of hPCRCT as a first line of management over the short term. Nevertheless, it is stressed that longer term outcomes remain unsupported at present.
> From: Kong et al., Am J Sports Med 46 (2018-02-23 15:00:36) 79-86. All rights reserved to The Author(s). Click here for the online summary.