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Degenerative Rotator Cuff Tears

Refining Surgical Indications Based on Natural History Data

Keener, Jay D., MD; Patterson, Brendan M., MD; Orvets, Nathan, MD; Chamberlain, Aaron M., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: March 1, 2019 - Volume 27 - Issue 5 - p 156–165
doi: 10.5435/JAAOS-D-17-00480
Review Article

Degenerative rotator cuff tears are the most common cause of shoulder pain and have a strong association with advanced aging. Considerable variation exists in surgeons' perceptions on the recommended treatment of patients with painful rotator cuff tears. Natural history studies have better outlined the risks of tear enlargement, progression of muscle degeneration, and decline in the function over time. This information combined with the known factors potentially influencing the rate of successful tendon healing such as age, tear size, and severity of muscle degenerative changes can be used to better refine appropriate surgical indications. Although conservative treatment can be successful in the management of many of these tears, risks to nonsurgical treatment also exist. The application of natural history data can stratify atraumatic degenerative tears according to the risk of nonsurgical treatment and better identify tears where early surgical intervention should be considered.

From the Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, St. Louis, MO.

Dr. Keener or an immediate family member has received royalties from Genesis, Shoulder Innovations, and Imascap; serves as a paid consultant to Arthrex; and has received research or institutional support from the National Institutes of Health (NIAMS and NICHD) and Zimmer Biomet. Dr. Patterson or an immediate family member is an employee of Disk-Criminator. Dr. Chamberlain or an immediate family member serves as a paid consultant to Arthrex, DePuy, and Zimmer Biomet and has received research or institutional support from Zimmer Biomet. Neither Dr. Orvets nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Supported by NIH grant: R01-051026.

© 2019 by American Academy of Orthopaedic Surgeons
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