Quinlan Noah J, Frandsen Jeffrey J, Smith Karch M, Lu Chao-Chin, Chalmers Peter N, Tashjian Robert Z
Orthopaedic Resident, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A.
Research Associate, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A.
Arthrosc Sports Med Rehabil. 2022 Jun 15;4(4):e1449-e1455. doi: 10.1016/j.asmr.2022.05.004. eCollection 2022 Aug.
To determine the likelihood of, and risk factors for, progression of rotator cuff tendinopathy to tear on magnetic resonance imaging (MRI) in patients treated conservatively for minimum 1 year.
Patients in the Veterans Health Administration (VHA) Corporate Data Warehouse with a diagnosis of rotator cuff injury and sequential MRI of the same shoulder at least 1 year apart were identified. Presenting MRIs were reviewed to select patients with tendinopathy, while excluding those with a normal appearing cuff, tear, or prior repair. Tear progression was defined as development of a partial or full-thickness tear on follow-up MRI. Chart review was performed for demographic and clinical data. Descriptive statistics and inter-observer and intra-observer reliability were calculated. Discrete and continuous variables were compared between patients who progressed and those who did not using chi-square, Fisher's Exact, Student's , and Mann-Whitney -test.
In the VHA database, 135 patients had an initial MRI demonstrating rotator cuff tendinopathy. On subsequent MRI at mean 3.4 year follow-up, 39% of patients had progressed to a tear. When grouped on the basis of time between scans as 1 to 2 years, 2 to 5 years, or over 5 years, the rate of progression was 32%, 37%, and 54% respectively. No factors were associated with progression.
Among patients with symptomatic rotator cuff tendinopathy that remained symptomatic at a minimum of 1 year and obtained a follow-up MRI, 39% progressed to a partial or full-thickness tear. None of the factors evaluated in this study correlated with progression from tendinopathy to tear. When patients were grouped based on time between scans as 1 to 2 years, 2 to 5 years, or more than 5 years, the rate of progression from tendinopathy to tear was 32%, 37%, and 54%, respectively.
确定保守治疗至少1年的患者肩袖肌腱病在磁共振成像（MRI）上进展为撕裂的可能性及危险因素。
在退伍军人健康管理局（VHA）企业数据仓库中，识别出诊断为肩袖损伤且同一肩部连续MRI间隔至少1年的患者。对初次MRI进行评估，选择患有肌腱病的患者，同时排除那些肩袖外观正常、有撕裂或既往有修复史的患者。撕裂进展定义为随访MRI时出现部分或全层撕裂。对人口统计学和临床数据进行病历审查。计算描述性统计量以及观察者间和观察者内的可靠性。使用卡方检验、Fisher精确检验、学生t检验和Mann-Whitney U检验比较进展组和未进展组患者的离散和连续变量。
在VHA数据库中，135例患者初次MRI显示肩袖肌腱病。平均随访3.4年的后续MRI检查中，39%的患者进展为撕裂。按扫描间隔时间分为1至2年、2至5年或5年以上进行分组时，进展率分别为32%、37%和54%。无因素与进展相关。
在有症状的肩袖肌腱病且至少1年仍有症状并接受随访MRI检查的患者中，39%进展为部分或全层撕裂。本研究评估的因素均与肌腱病进展为撕裂无关。当按扫描间隔时间将患者分为1至2年、2至5年或超过5年时，肌腱病进展为撕裂的发生率分别为32%、37%和54%。
