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Description
The Multicenter Orthopaedic Outcomes Network Shoulder Group conducted a prospective cohort study of 452 patients with symptomatic atraumatic rotator cuff tears treated with a physical therapy program to determine the predictors of failure of nonsurgical treatment, to provide insight into indications for surgery. After 10 years, we found the following: (1) Physical therapy was effective for over 70% of patients. (2) PROMs showed statistical and clinical improvement after 12 weeks of therapy and did not decline over 10 years. (3) Cuff tear severity did not correlate with pain, duration of symptoms, or activity level. (4) Of those who had surgery, 56.7% had surgery in the first 6 months while 43.3% had surgery between 6 months and 10 years. (5) Early surgery was primarily driven by low patient expectations regarding the effectiveness of therapy. (6) Later surgery predictors included workers' compensation status, activity level, and patient expectations. (7) Only 1 patient had a reverse arthroplasty (0.2% of the cohort). These data suggest that physical therapy is an effective and durable treatment of atraumatic symptomatic rotator cuff tears and most patients successfully treated with physical therapy do not exhibit a decline in patient-reported outcomes over time. Reverse arthroplasty after nonsurgical treatment is exceptionally rare.
Learning Objectives
1) Appreciate the Relationship between Symptoms and Rotator Cuff Tears
2) Understand the Predictors of Surgery and How they Change over Time in Patients whose Rotator Cuff Tears are Treated Nonoperatively
3) Gain insight into why progression of rotator cuff tears may not be important for most people
4) Appreciate that rotator cuff tears are incidental for most people, but a very small minority have significant problems with their rotator cuff tears
Director: Eric Wagner, MD, MS, FAAOS, CAQ
Faculty: Moon Shoulder Group
John E. Kuhn, MD, MS, Warren R Dunn, MD, MPH, Rosemary R Sanders, BS, Keith M Baumgarten, MD, Julie Y Bishop, MD, Robert H Brophy, MD, James L. Carey, MD MPH, Brian G Holloway, MD, Grant L Jones, MD, C Ben Ma, MD, Robert G Marx, MD, MS, Eric C McCarty, MD, Sourav K Poddar, MD, Matthew V Smith, MD, Edwin E Spencer, MD, Armando F Vidal, MD, Brian R Wolf, MD, MD, Rick W Wright, MD
The American Academy of Orthopaedic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.