Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR Iran.
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR Iran.
J Shoulder Elbow Surg. 2020 Jan;29(1):113-120. doi: 10.1016/j.jse.2019.05.009. Epub 2019 Aug 6.
Further studies are required to determine the effectiveness of conservative treatment of partial-thickness rotator cuff tear (PTRCT). Here, we aim to identify the predictors of failure after conservative treatment in a large series of patients with symptomatic PTRCT.
The outcome of conservative treatment in a retrospective cohort of 272 patients with symptomatic PTRCT was evaluated. Demographic, clinical, and radiographic characteristics were extracted from the patients' medical records. Subjective assessments included Constant Shoulder Score (CSS), visual analog scale for pain (VAS pain), activities of daily living (ADL) score, and American Shoulder and Elbow Surgeons (ASES) score, all performed at the first visit. The association of treatment failure with the patient/tear characteristics was assessed.
The bursal-type PTRCT was associated with male gender (P = .02), earlier referral of the patients (P = .001), more nonsteroidal anti-inflammatory drug consumption (P = .004), more positive painful arc syndrome (P = .006), and lower CSS (P < .001). These symptoms subsided completely or considerably in 172 (63.2%) patients after the conservative treatment, from which the disease relapsed in 21 (12.2%) patients at the mean follow-up of 22.2 ± 8.8 months. The symptoms led to surgery in the remaining 100 (36.8%) patients. The failure rate of conservative treatment was significantly higher in the dominant injuries (P = .015), the bursal type (P < .001), and tears involving more than 50% of the depth of the tendon (P < .001).
The bursal type tear, dominant tears, and tears involving >50% of the tendon depth are factors capable of predicting failure after conservative management of PTRCT.
需要进一步的研究来确定保守治疗部分厚度肩袖撕裂（PTRCT）的有效性。在这里，我们旨在确定在大量有症状的 PTRCT 患者中，保守治疗失败的预测因素。
回顾性分析了 272 例有症状的 PTRCT 患者的保守治疗结果。从患者的病历中提取了人口统计学、临床和影像学特征。主观评估包括 Constant 肩部评分（CSS）、疼痛视觉模拟评分（VAS 疼痛）、日常生活活动（ADL）评分和美国肩肘外科医师协会（ASES）评分，所有评分均在首次就诊时进行。评估治疗失败与患者/撕裂特征的关系。
滑囊型 PTRCT 与男性性别（P =.02）、患者就诊时间更早（P =.001）、非甾体抗炎药使用更多（P =.004）、更积极的疼痛弧综合征（P =.006）和较低的 CSS（P <.001）相关。在接受保守治疗后，172 例（63.2%）患者的这些症状完全或明显缓解，其中 21 例（12.2%）患者在平均 22.2 ± 8.8 个月的随访中疾病复发。其余 100 例（36.8%）患者的症状导致手术。在优势损伤（P =.015）、滑囊型（P <.001）和累及肌腱深度超过 50%的撕裂（P <.001）中，保守治疗的失败率明显更高。
滑囊型撕裂、优势撕裂和累及肌腱深度超过 50%的撕裂是保守治疗 PTRCT 失败的预测因素。
