Shoulder
Patterns of tear progression for asymptomatic degenerative rotator cuff tears

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Background

The purpose of this study was to examine patterns of rotator cuff tear size progression in degenerative rotator cuff tears and to compare tear progression risks for tears with and without anterior supraspinatus tendon disruption.

Methods

Asymptomatic full-thickness rotator cuff tears with minimum 2-year follow-up were examined with annual shoulder ultrasound examinations. Integrity of the anterior 3 mm of the supraspinatus tendon determined classification of cable-intact vs. cable-disrupted tears. Tear enlargement was defined as an increase of 5 mm or more in width. Tear propagation direction was calculated from measured changes in tear width in reference to the biceps tendon on serial ultrasound examinations.

Results

The cohort included 139 full-thickness tears with a mean subject age of 63.3 years and follow-up duration of 6.0 years. Ninety-six (69.1%) of the tears were considered cable intact. Cable-disrupted tears were larger at baseline (median, 19.0 mm vs. 10.0 mm; P < .0001) than cable-intact tears. There was no difference in the risk of enlargement (52.1% vs. 67.4%; P = .09) or time to enlargement (3.2 vs. 2.2 years; P = .37) for cable-intact compared with cable-disrupted tears. There was no difference in the magnitude of enlargement for cable-intact and cable-disrupted tears (median, 7.0 mm vs.9.0 mm; P = .18). Cable-intact tears propagated a median of 5 mm anteriorly and 4 mm posteriorly, whereas cable-disrupted tears propagated posteriorly.

Conclusions

The majority of degenerative rotator cuff tears spare the anterior supraspinatus tendon. Although tears classified as cable disrupted are larger at baseline than cable-intact tears, tear enlargement risks are similar for each tear type.

Section snippets

Methods

Subjects for this study belong to a cohort of individuals with asymptomatic rotator cuff tears that have been observed longitudinally for the purpose of defining the risks of tear enlargement and pain development over time. Subjects presented to the physician with shoulder pain secondary to rotator cuff disease and were found to have an asymptomatic rotator cuff tear in the contralateral shoulder with shoulder ultrasonography. After tear identification, subjects were confirmed to be

Tear propagation analysis

A total of 181 shoulders from the prospective cohort were identified to have a full-thickness cuff tear and a minimum of 2-year follow-up. Forty-two shoulders were excluded because of missing ultrasound data regarding the distance of the tear from the biceps tendon/groove. Therefore, 139 full-thickness tears possessed adequate data and follow-up for tear enlargement analysis. Thirty-three of these shoulders were originally enrolled as partial-thickness tears and 5 were originally designated

Discussion

Understanding common patterns of tear enlargement is fundamental for both surgical indications and surgical repair strategies. To properly illustrate directions of tear enlargement or propagation patterns of tears, a longitudinal analysis is ideal as direct comparisons of changing tear dimensions can be established in a prospective fashion. The asymptomatic cuff tear may also be ideal for this analysis as treatments that may influence disease progression are not rendered, given the tear is

Conclusions

The majority of asymptomatic degenerative rotator cuff tears do not involve the anterior aspect of the supraspinatus tendon. Tears defined as cable disrupted are larger than cable-intact tears. Cable-intact tears appear to propagate in both the anterior and posterior directions, whereas cable-disrupted tears propagate posteriorly within the rotator crescent. The risks, magnitude, and time line of tear progression for cable-intact and cable-disrupted full-thickness tears appear similar, and thus

Disclaimer

Jay D. Keener and Aaron M. Chamberlain have potential conflicts that are not related to the content of this study.

Ken Yamaguchi receives royalties from Tornier for elbow arthroplasty systems and is a design consultant for Zimmer for shoulder arthroplasty.

The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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  • Cited by (0)

    This study was funded by the National Institutes of Health: NIH R01-AR051026.

    Institutional Review Board approval for this study was provided by Washington University in St. Louis: No. 201103230.

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