Long-Term Clinical Outcomes and Factors Associated With Response in Older Adults With Massive Irreparable Rotator Cuff Tears: A Four-Year Prospective Cohort Study

IMPORTANCE: Few studies that have reported long-term trajectories of a standardized nonoperative management in patients with massive irreparable rotator cuff tears (MIRCTs). OBJECTIVE: The aims of this study were to describe the long-term clinical outcomes of nonoperative treatment and to analyze sociodemographic and comorbidity baseline factors associated with functional outcomes trajectories in older adults with atraumatic MIRCTs. DESIGN: A prospective cohort study was performed. SETTING: The setting was a single tertiary health care hospital. PARTICIPANTS: Patients aged ≥60 years with atraumatic MIRCTs were recruited. INTERVENTIONS: All patients were treated with Nonsteroidal anti-inflammatory drugs, a 12-week physical therapist program, home exercises, and, when required, a corticosteroid injection. MAIN OUTCOMES AND MEASURES: The Constant-Murley (CM) questionnaire was used to assess shoulder function, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire for upper limb function, and the Visual Analog Scale (VAS) for pain intensity. Four evaluations were performed, at baseline, at 3 months, 1 year, and 4 years. Because outcomes were measured repeatedly in the same participants, linear mixed-effects models with random intercepts were used to account for within-subject correlation. RESULTS: The majority of patients (76/92) showed clinically important improvements in 3 months that persisted until 4 years. Of the patients that did not improve at 1-year, 16 underwent surgery (17%). In patients treated nonoperatively, in CM, DASH, and VAS, the minimal clinically important difference (MCID) was reached between 95% to 97% of patients at 3 months, 89% to 97% at 1 year, and all patients at 4 years (100%). In the prespecified adjusted models, longer symptoms duration (β = -1.3; 95% CI = -1.7 to -0.8) and smoking (β = -8.8; 95% CI = -13.2 to -4.4) were associated with worse shoulder function. Diabetes mellitus was associated with higher pain intensity (β = 0.3; 95% CI = 0.1 to 0.5). CONCLUSIONS: In the long term, the majority of older patients with atraumatic MIRCTs in this cohort responded well to nonoperative treatment. Moreover, some sociodemographic and comorbidity baseline factors were associated with functional recovery trajectories in these patients. However, further research is needed to confirm these findings. RELEVANCE: Findings showed that functional recovery trajectories are significantly influenced not only by biomechanical or related to rotator cuff tear factors but by modifiable sociodemographic and comorbidity factors which should be addressed in these patients.