Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada.
Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
J Shoulder Elbow Surg. 2021 Feb;30(2):449-455. doi: 10.1016/j.jse.2020.08.022. Epub 2020 Sep 10.
Partial-thickness rotator cuff tears are likely at least as common as full-thickness rotator cuff tears, and it is critical for surgeons to have knowledge of the tear progression rate of partial-thickness rotator cuff tears when determining surgical or nonsurgical treatment. However, a systematic review investigating the rate of tear progression of partial-thickness rotator cuff tears has not been performed. Therefore, the purpose of this study was to systematically review the literature and determine the rate of full-thickness progression in nonoperatively treated partial-thickness rotator cuff tears.
A systematic review of the literature was performed following the PRISMA guidelines and checklist using the PubMed, MEDLINE, and Cochrane Library databases. English-language studies of Level I through IV evidence examining partial-thickness rotator cuff tears with description of the change in tear size were included. Studies using imaging modalities other than magnetic resonance imaging (MRI) or ultrasonography (US) for serial imaging and studies without description of the number of tears that progressed to full-thickness tears were excluded. The primary outcome was to determine the per-month progression rate from a partial-thickness tear to a full-thickness tear confirmed on either MRI or US. The progression rates, which were divided into 3 groups-symptomatic, asymptomatic and combined (asymptomatic + symptomatic)-were calculated using a random effects model with binomial within-study variance.
Four studies were included, and 257 tears were analyzed statistically for tear progression. The average follow-up was 34 months (standard deviation, 19 months). The overall rate of progression to a full-thickness tear was 0.26% per month (95% confidence interval [CI], 0.15%-0.36% per month). In the symptomatic and asymptomatic groups, the rates were 0.22% per month (95% CI, 0.09%-0.34% per month) and 0.32% per month (95% CI, 0.15%-0.49% per month), respectively, which showed no significant difference (P =.341).
This study demonstrated that partial-thickness tears progress to full-thickness tears over time but at a relatively low rate at short- to intermediate-term follow-up. There was no significant difference in the per-month rates of full-thickness progression between symptomatic and asymptomatic tears.
部分厚度肩袖撕裂的可能性至少与全层肩袖撕裂一样常见，当确定手术或非手术治疗时，外科医生了解部分厚度肩袖撕裂的撕裂进展率至关重要。然而，尚未进行专门研究部分厚度肩袖撕裂撕裂进展率的系统评价。因此，本研究的目的是系统地审查文献，并确定非手术治疗的部分厚度肩袖撕裂的全层进展率。
按照 PRISMA 指南和检查表，使用 PubMed、MEDLINE 和 Cochrane 图书馆数据库进行系统的文献回顾。纳入了研究部分厚度肩袖撕裂并描述撕裂大小变化的 I 级至 IV 级证据的英语语言研究。排除了使用磁共振成像（MRI）或超声（US）以外的成像方式进行连续成像的研究以及未描述进展为全层撕裂的撕裂数量的研究。主要结局是确定从部分厚度撕裂到经 MRI 或 US 证实的全层撕裂的每月进展率。使用随机效应模型和二项式内研究方差，计算出进展率，将其分为 3 组-有症状、无症状和合并（有症状+无症状）。
纳入了 4 项研究，对 257 个撕裂进行了统计学分析。平均随访时间为 34 个月（标准差为 19 个月）。进展为全层撕裂的总体速率为每月 0.26％（95％置信区间，每月 0.15％-0.36％）。在有症状和无症状组中，比率分别为每月 0.22％（95％置信区间，每月 0.09％-0.34％）和每月 0.32％（95％置信区间，每月 0.15％-0.49％），无显著差异（P =.341）。
本研究表明，部分厚度撕裂会随着时间的推移逐渐发展为全层撕裂，但在短期至中期随访中进展速度相对较慢。有症状和无症状撕裂的全层进展每月比率之间没有显着差异。
