Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
J Shoulder Elbow Surg. 2020 Jun;29(6):1168-1176. doi: 10.1016/j.jse.2019.10.027. Epub 2020 Feb 7.
The natural course of and risk factors for tear progression in full-thickness rotator cuff tears (FTRCTs) have not been clarified yet. The study's purpose was to retrospectively evaluate tear progression in FTRCTs by using magnetic resonance imaging (MRI) and to identify risk factors that are relevant to such tear progression.
Between June 2010 and September 2019, a total of 345 patients with FTRCTs who had been diagnosed via MRI were treated conservatively. Of these, 48 patients who underwent post-treatment follow-up MRI were retrospectively enrolled. Tear progression was defined as significant when the tear size increased by >5 mm.
The mean MRI follow-up duration was 22 ± 14 months (range, 12-65 months). Among the 48 patients (mean age, 69 years; range, 53-81), 26 (54%) and 20 (41%) showed medial-lateral (M-L) and anterior-posterior (A-P) tear progression on MRI follow-up. Multivariate analysis revealed that MRI follow-up duration (P = .011), diabetes mellitus (P = .017), and infraspinatus muscle atrophy (P = .011) were independent risk factors for tear progression in the A-P plane. A high critical shoulder angle (P = .011) and supraspinatus (P = .024) and infraspinatus (P = .020) muscle atrophy were risk factors associated with M-L tear progression.
Among the assessed patients, a considerable number of FTRCTs increased in size during the follow-up period. Severe infraspinatus muscle atrophy was the independent risk factor for exacerbation of A-P and M-L tear progression.
全层肩袖撕裂（FTRCT）的自然病程和撕裂进展的危险因素尚未明确。本研究的目的是通过磁共振成像（MRI）回顾性评估 FTRCT 的撕裂进展，并确定与撕裂进展相关的危险因素。
2010 年 6 月至 2019 年 9 月，共对 345 例经 MRI 诊断为 FTRCT 的患者进行了保守治疗。其中，48 例接受了治疗后随访 MRI 的患者被回顾性纳入研究。当撕裂大小增加>5mm 时，定义为显著进展。
MRI 随访平均时间为 22±14 个月（范围 12-65 个月）。在 48 例患者（平均年龄 69 岁，范围 53-81 岁）中，26 例（54%）和 20 例（41%）在 MRI 随访中出现了横向和前后撕裂进展。多变量分析显示，MRI 随访时间（P=.011）、糖尿病（P=.017）和冈下肌萎缩（P=.011）是 A-P 平面撕裂进展的独立危险因素。高临界肩角（P=.011）、冈上肌（P=.024）和冈下肌（P=.020）萎缩是与 M-L 撕裂进展相关的危险因素。
在所评估的患者中，相当一部分 FTRCT 在随访期间增大。严重的冈下肌萎缩是 A-P 和 M-L 撕裂进展恶化的独立危险因素。
