Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2021; 12(4): 223-233
Published online Apr 18, 2021. doi: 10.5312/wjo.v12.i4.223
Predictors of clinical outcomes after non-operative management of symptomatic full-thickness rotator cuff tears
Christopher Bush, Joel J Gagnier, James Carpenter, Asheesh Bedi, Bruce Miller
Christopher Bush, Joel J Gagnier, James Carpenter, Asheesh Bedi, Bruce Miller, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48106, United States
Author contributions: All authors designed the research study; Carpenter J, Bedi A and Miller B recruited and treated the study patients; Bush C and Gagnier JJ performed the data analysis, Bush C wrote the manuscript; all authors have read, extensively edited and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the University of Michigan Institutional Review Board (study No. HUM0024612).
Informed consent statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Christopher Bush, MD, Lecturer, Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, P.O. Box 391, Ann Arbor, MI 48106, United States.
Received: December 15, 2020
Peer-review started: December 15, 2020
First decision: December 31, 2020
Revised: January 17, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: April 18, 2021
Research background

Rotator cuff tears are extremely prevalent in the general population, and many patients with rotator cuff tears can be treated successfully without surgical intervention. Little data exists in the literature regarding patient and pathology related factors which predict the outcomes after nonsurgical management.

Research motivation

By evaluating the patient reported outcomes in a cohort of patients who underwent nonsurgical management for full-thickness rotator cuff tears, we hope to uncover important factors which may refine treatment indications for this subset of patients.

Research objectives

The objectives of this study were to evaluate the outcomes of nonsurgical management in patient with full thickness rotator cuff tears, and to identify patient and tear related characteristics which may predict outcomes. These findings could have a significant impact on the treatment of patients with rotator cuff tears in the future.

Research methods

Patients in our institutional registry who underwent nonsurgical management for full thickness rotator cuff tears were identified. Pre-treatment magnetic resonance imaging scans were evaluated for tear size and related muscle atrophy and fatty infiltration. Patient reported outcomes were evaluated at 1 and 2 years after treatment began and regression analyses were performed in order to identify any predictors of patient reported outcomes in this cohort.

Research results

Patient reported outcome measures improved significantly at 1 and 2 year follow up after nonsurgical management. Patients who presented with chronic symptoms showed less improvement in patient reported outcome scores, and those with traumatic tears were noted to make greater improvements over the course of the study.

Research conclusions

Patients with full thickness rotator cuff tears can achieve significant clinical improvement with nonsurgical management. Several factors may affect the amount of improvement they achieve, including the duration of their symptoms at presentation and the mechanism of their pain at the onset of symptoms. Additional factors likely exist that may impact patient outcomes in the setting of rotator cuff pathology.

Research perspectives

Future studies should consider additional factors that may be relevant in predicting outcomes in patients with rotator cuff tears including pertinent physical exam findings and concomitant shoulder pathology such as biceps tendon involvement. Prospective comparative studies of surgical and nonsurgical management will also help clarify the ideal surgical and non-surgical indications in this cohort of patients.