Symptomatic Rotator Cuff Tear Progression: Conservatively Treated Full- and Partial-Thickness Tears Continue to Progress

Abstract

Purpose: To determine the likelihood of and risk factors for tear progression among patients with a symptomatic partial or full-thickness rotator cuff tears (RCTs) who return with continued shoulder pain and obtain subsequent magnetic resonance imaging (MRI) and to identify various patient factors and MRI findings associated with rotator cuff tear progression. Methods: We performed a retrospective review of MRI studies from Veteran’s Affair patients with conservatively treated partial- or full-thickness rotator cuff tears. Patient characteristics and demographics were obtained via chart review. Tear characteristics were measured on MRI obtained a minimum of 1 year apart. We defined progression as either (1) an increase from a partial to a full-thickness tear or (2) an increase in tear width or retraction of at least 5 mm. Statistical analysis using χ2, Fisher exact, Student t, and Mann–Whitney U test was then performed as appropriate, looking for factors involved in RCT progression. Results: We evaluated 412 MRI studies from 206 Veteran’s Affair patients with conservatively treated partial- or full-thickness rotator cuff tears from October 1999 to March 2020. Overall, 61% of RCTs had progressed at a mean of 3.2 ± 2.3 years follow-up. Among all patients, 74% of full-thickness tears progressed in size, 42% of partial-thickness tears progressed in size, and 29% of partial-thickness tears progressed to full-thickness tears. On univariate analysis, full-thickness tears (P < .001), disruption of the anterior rotator cuff cable (P = .001), subscapularis involvement (P = .004), tear retraction (P < .001), and tear width (P < .001) all increased the likelihood of progression. On multivariate analysis, full-thickness tears (P < .001) and subscapularis involvement (P = .045) were correlated with progression. Conclusions: RCTs progress over time in terms of size of tear and from partial- to full-thickness tears. There is an increased risk of tear progression in patients with full-thickness tears when compared with partial-thickness tears along with subscapularis tear involvement. Rates of progression are larger than previously reported rates for both partial- and full-thickness tears, noting that our study population were those patients who continued to be symptomatic from their tears. Level of Evidence: Level IV, prognostic case series.