A recent study aimed to look at whether the outcome of nonoperative treatment of a rotator cuff tear could be predicted on the basis of the patient’s baseline clinical presentation. It additionally wanted to examine whether a successful outcome achieved after three months of treatment in a symptomatic full-thickness rotator cuff tear would be maintained at two years time. Rotator cuff pathology is among the most common causes of shoulder pain. The spectrum of this pathology can span from rotator cuff syndrome all the way to full thickness tearing. Decisions regarding treatment can be complicated as clinical symptoms may not always correlate with extent of damage or degeneration present on imaging. Many surgeons will choose to use an adequate course of nonoperative conservative management lasting at least three months before surgery is considered. However, there is no standard definition of what this “adequate” nonoperative treatment may consist of. Additionally, this may differ from one patient to the next.
The dependent variable used in the prospective cohort study mentioned above, was the outcome of nonoperative treatment classified as either success or failure at the patient’s three-month follow up appointment. Successful treatment was defined that surgery was no longer deemed appropriate by both the patient and the surgeon as the patient demonstrated considerable improvement and was predominantly asymptomatic. If the patient elected to schedule surgery the nonoperative treatment was deemed to have failed. Ten clinical baseline measurements were utilized and examined for their predictive ability. Examples of these baseline measures include age, sex, duration, onset, strength, range of motion, and Rotator Cuff Index Measure. Originally 104 patients met the inclusion and exclusion criteria. Each participant had a documented chronic full-thickness rotator cuff tear and underwent a series of five visits including two with a sports medicine physician, two with a physiotherapist, and one with an orthopedic surgeon. The rehabilitation program included stretching and strengthening exercises. At three months time the patient was scheduled to meet with the orthopedic surgeon whom they had originally been assigned to. After examination, the surgeon classified the outcome of rehabilitation as either a success or failure. The Rotator Cuff Quality-of-Life Index (RC-QOL) instrument was administered at the patient’s first visit, again on arrival at their three-month surgical consultation and then again twenty-four months after their initial baseline assessment. It should be noted that both the sports medicine physician and orthopedic surgeon were blinded to the RC-QOL results.
For analysis, patients were grouped on the basis of outcome of their nonoperative treatment, and the ability to predict this outcome on the basis of the baseline characteristics. Of the original 104 patients ninety-three were analyzed. Seventy five percent of the patients were classified as having a successful outcome at their three-month consultation visit. It was found that the only baseline characteristic that was significant in prediction of success or failure in the analysis was the RC-QOL. Two-year follow up demonstrated that eighty nine percent of the patients maintained their three-month outcome (success or failure). The authors of this article believe these results demonstrate that the RC-QOL can be utilized to determine whether the patient is likely to have a successful or failed outcome in a course of nonoperative treatment.