Summary

A retrospective cohort study designed to identify risk factors that increase likelihood of surgery within 3 months of initial presentation after failure of non-operative management for degenerative rotator cuff tears.

Abstract

Background

A number of risk factors for the general failure of non-operative management in the treatment of atraumatic, degenerative rotator cuff tears (RCT) have been identified. However, to date, there is a paucity of research investigating how these risk factors are related to the timing of the failure of non-operative management. A study incorporating this temporal factor would assist physicians and patients to determine when an individual patient is likely to need surgical intervention. The aim of this study was to determine risk factors, including duration of symptoms from initial date of onset to presentation, for early surgical intervention.

Methods

A retrospective cohort study was performed of patients with degenerative, atraumatic RCT who underwent surgery by two fellowship-trained shoulder surgeons and had at least 12 months of postoperative follow-up. These patients were divided into two cohorts based on duration of time between index presentation to the surgeon and intervention: early (fewer than 3 months) and delayed (greater than 3 months). Patient characteristics such as demographics, comorbidities, individually and combined via the Functional Comorbidity Index and Charlson Comorbidity Index, clinical findings and shoulder/rotator cuff tear characteristics were collected and data analysis was performed.

Results

144 patients met inclusion criteria, which was failure of at least 6 weeks of physical therapy +/- a glucocorticoid injection. One hundred seven patients (74%) underwent surgery within 3 months of presentation, and 37 (26%) underwent surgery after at least 3 months. Analysis revealed duration of symptoms prior to presentation is a prognostic factor for early versus late surgery (=3 months: 5 (14%) early group, 39 (36%) late group, 4-10 months: 11 (30%) early, 27 (25%) late, 11-25 months: 16 (43%) early, 28 (26%) late, >25 months: 5 (14%) early, 12 (11%) late; p-value 0.05). Additionally, no current tobacco use increased likelihood of undergoing surgery early (early: 96/106 (90%), delayed: 28/37 (76%); p-value 0.04). Age was also a predictive factor with older patients, on average, being more likely to require surgery earlier (mean age: early: 56 +/- 9, delayed: 61 +/- 11; p-value 0.02). Patients who experienced night pain were more likely to fail non-operative treatment earlier (early: 89/94 (95%), delayed: 27/34 (79%); p-value 0.02). Patients with an external rotation strength less than 5/5 were more likely to undergo surgery within 3 months of presentation (early: 58/107 (54%), delayed: 12/36 (33%); p-value 0.03).

Conclusions

This study found that the major risk factors for failure of non-operative management within 3 months of index presentation are shorter length of time from symptom onset to presentation, older age, presence of night pain, and an external strength less than full strength. This information may help guide informed decision making.