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Kuhn JE, Dunn WR, Sanders R, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Holloway BG, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW. 2024 Kappa Delta Ann Doner Vaughan Award Nonsurgical Treatment of Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears-a Prospective Multicenter Cohort Study With 10-Year Follow-Up. J Am Acad Orthop Surg 2024:00124635-990000000-01106. [PMID: 39325825 DOI: 10.5435/jaaos-d-24-00841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 08/02/2024] [Indexed: 09/28/2024] Open
Abstract
The Multicenter Orthopaedic Outcomes Network Shoulder Group conducted a prospective cohort study of 452 patients with symptomatic atraumatic rotator cuff tears treated with a physical therapy program to determine the predictors of failure of nonsurgical treatment, to provide insight into indications for surgery. After 10 years, we found the following: (1) Physical therapy was effective for over 70% of patients. (2) PROMs showed statistical and clinical improvement after 12 weeks of therapy and did not decline over 10 years. (3) Cuff tear severity did not correlate with pain, duration of symptoms, or activity level. (4) Of those who had surgery, 56.7% had surgery in the first 6 months while 43.3% had surgery between 6 months and 10 years. (5) Early surgery was primarily driven by low patient expectations regarding the effectiveness of therapy. (6) Later surgery predictors included workers' compensation status, activity level, and patient expectations. (7) Only 1 patient had a reverse arthroplasty (0.2% of the cohort). These data suggest that physical therapy is an effective and durable treatment of atraumatic symptomatic rotator cuff tears and most patients successfully treated with physical therapy do not exhibit a decline in patient-reported outcomes over time. Reverse arthroplasty after nonsurgical treatment is exceptionally rare.
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Affiliation(s)
- John E Kuhn
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Warren R Dunn
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Rosemary Sanders
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Keith M Baumgarten
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Julie Y Bishop
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - James L Carey
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Brian G Holloway
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Grant L Jones
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Robert G Marx
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Eric C McCarty
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Sourav K Poddar
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Matthew V Smith
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Edwin E Spencer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Armando F Vidal
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Brian R Wolf
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Kuhn, Sanders, and Wright), bFrondren Orthopaedic Group, Houston TX (Dunn), Orthopedic Institute, Sioux Falls, SD (Baumgarten), Department of Orthopaedics, The Ohio State University, Columbus, OH (Bishop and Jones), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Brophy and Smith), Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Carey), Knoxville Orthopaedic Clinic, Knoxville, TN (Holloway and Spencer), Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA (Ma), Hospital for Special Surgery, New York, NY (Marx, McCarty, and Poddar)
- jDepartment of Orthopaedic Surgery, University of Colorado Sports Medicine Center, Denver, CO, USA
- kThe Steadman Clinic, Vail, CO, USA (Vidal)
- lDepartment of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA (Wolf)
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