Cuff Tear Arthropathy Following Non-Operative Treatment of Massive Rotator Cuff Tear – Long Term Outcome

Netanel Agajany 1 Shaul Beyth 2 Charles Milgrom 2 Ori Safran 2
1Medical School, Hebrew University, Jerusalem, Israel
2Orthopedic Surgery, Hadassah Medical Center, Jerusalem, Israel

Introduction: Massive rotator cuff tear (RCT) may result in complete derangement of the glenohumeral joint, termed Cuff Tear Arthropathy (CTA). In order to preserve shoulder function and avoid CTA patients are advised to undergo surgical repair of the tendon whenever possible. To date, little is known of the long term natural history of massive RCT and the incidence of CTA in patients who were treated non-operatively.

Methods: In this IRB approved historical prospective study, we reviewed all shoulder ultrasound examinations performed by a senior musculoskeletal radiologist in our medical center between 1997-2002, and identified a cohort of patients who were diagnosed with massive cuff tear. Patients who were available for the study and met inclusion criteria were evaluated clinically and radiographically. X-Ray images were reviewed by two fellowship trained senior orthopedic surgeons for the presence and severity of CTA, according to Seebauer`s classification.

Results: We reviewed 1500 ultrasound examinations to yield 53 patients with 59 massive rotator cuff tears who refused to undergo surgical treatment. Of those, 21 were unavailable for the study and 13 did not meet inclusion criteria. Of 25 patients examined (follow up 14.9 years ± 1.3), 22 patients (88%) had radiographic evidence of CTA. Thirteen patients (52%) had Seebauer IA CTA, and 9 had Seebauer IIA CTA (36%). There were no statistically significant differences between different age groups, dominant side, or gender, regarding the possibility of developing CTA. Both patients with and without CTA had poor quality of life and function with no statistically significant differences as measured in DASH score and Constant Murley shoulder outcome score.

Conclusion: Our results show that the long term natural history of massive RCT under non-operative management is not favorable, with regards to the possibility of developing CTA. Furthermore, there are no protective demographic attributes from developing CTA. The long term clinical outcome of non-surgical treatment of massive RCT is not optimal, even in patients who did not develop CTA.