J Korean Orthop Assoc.  2018 Feb;53(1):38-43. 10.4055/jkoa.2018.53.1.38.

A Follow-Up Study of Rotator Cuff Tear Using Magnetic Resonance Imaging

Affiliations
  • 1Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea. 99korean@naver.com

Abstract

PURPOSE
Rotator cuff disease (RCD) is a common cause of shoulder pain. However little is known about the progression of RCD during conservative management. This study aimed to identify the progression of RCD using magnetic resonance imaging (MRI).
MATERIALS AND METHODS
This study was conducted between 2013 and 2015; 48 patients who underwent MRI after at least one year of conservative treatment for RCD were enrolled for follow-up analysis. Rotator cuff tear (RCT) and retraction were measured using an MRI. Tear progression was defined as an increase of 3 mm or more in tear size or retraction. Patients were divided into two groups: Small tear group and medium/large tear group. The progression of tears was analyzed.
RESULTS
RCT occurred in 25 cases and tendinosis occurred in 23 cases. The progression was observed in 12 cases (48.0%), and new tears were observed in 2 cases (8.7%). The pre-treatment tear size and retraction were 17.8 mm and 18.9 mm, respectively; while the post treatment tear size and amount of tendon retraction were 20.2 mm and 22.3 mm, respectively. The pre-treatment anteroposterior diameter of tears showed a positive correlation with the pre-treatment tendon retraction (r=0.830, p < 0.001) but a negative correlation with the anteroposterior tear size progression (r=−0.473, p=0.017). Small size tears were found in 5 cases (20.0%) and medium/large size tears were found in 20 cases (80.0%). Among the 5 cases of small size tears, 4 cases (80.0%) showed progression, with a mean anteroposterior diameter of 7.4 mm and a mean amount of retraction of 5.9 mm. Among the 20 cases with medium/large size tears, 8 cases (40.0%) showed progression, with a mean anteroposterior diameter of 4.1 mm and a mean retraction of 6.8 mm. The frequency of tear progression was significantly different between the two groups (p < 0.001).
CONCLUSION
The need to use MRI monitoring during the conservative treatment of rotator cuff tears to evaluate the possibility of switching to surgical treatment. This study also suggests that an aggressive surgical treatment should be considered even for small tears, since the size of tear and retraction of tears may progress similarly regardless of the size of tear.

Keyword

rotator cuff; rotator cuff tear; conservative treatment; magnetic resonance imaging
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