Abstract
Background
Very little longitudinal information has been available regarding the relationship of cuff tears and arthritis. The purpose of this study was to determine the midterm risk of and risk factors for rotator cuff tear arthropathy progression in a cohort of subjects with an asymptomatic rotator cuff tear.
Methods
Baseline (visit 1), 5-year (visit 2), and most recent follow-up (visit 3) radiographs were reviewed in a cohort of 105 subjects enrolled for longitudinal surveillance of asymptomatic degenerative rotator cuff tears and 33 controls. The radiographs were assessed in a blinded, randomized fashion by 3 observers who graded glenohumeral arthritic changes using the Hamada scores, Samilson-Prieto (SPO) scores, and acromiohumeral interval (AHI).
Results
Osteoarthritis (SPO classification), cuff tear arthropathy (Hamada classification), and AHI progressed between visits 1 and 3 (median, 8 years; P < .001 in all cases). SPO progression was not significantly different for partial- vs. full-thickness vs. control baseline tear types (P = .19). Both full-thickness and partial-thickness tears had greater progression in Hamada scores than controls did in the first 5 years of follow-up (P = .02 and P = .03, respectively), but scores did not differ between partial- and full-thickness tears. Tears with and without enlargement did not differ in progression in SPO grade, Hamada grade, or AHI.
Conclusions
Glenohumeral arthritic changes progress significantly but remain minimal within an 8-year period in early to moderate degenerative cuff disease. Whereas the presence of a rotator cuff tear influences progression in Hamada grade, the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points.
Level of evidence
Level II; Prognosis Study
Keywords: Rotator cuff tear, rotator cuff tear arthropathy, osteoarthritis, natural history, shoulder pain, degenerative joint disease
The time line and risks of progression of degenerative rotator cuff disease to advanced rotator cuff tear arthropathy (RCTA) are unknown. An improved understanding of the risk factors for radiographic progression of cuff tears may improve treatment paradigms for patients with degenerative cuff tears. For many patients, rotator cuff tears progress over time in both size and symptoms.12,17,19 The end stage of this progression is the development of a characteristic set of degenerative changes including proximal humeral migration, acromial acetabularization, and glenohumeral chondral and bone loss, collectively described as RCTA.10,20,21 Although historically few reliable surgical options existed for this condition,5 the release of modern reverse total shoulder arthroplasty has led to an ever-increasing number of patients undergoing arthroplasty for the degenerative sequelae of rotator cuff tears.6,15,25
RCTA was originally described by Neer >3 decades ago20; however, the natural history remains poorly understood. Small, retrospective studies have described worsening radiographic deterioration in 39% to 92% of patients with long-term follow-up of surgically treated patients with massive rotator cuff tears.8,21,31,32 Alternatively, some retrospective series with long-term follow-up have described durable clinical results with rotator cuff repair.1,3,7,23,26 No study has prospectively examined rotator cuff tears radiographically to describe the progression of RCTA in a nonsurgical cohort. The risk factors for progression thus remain unknown.
Understanding the likelihood of progression of RCTA and the clinical attributes that modulate this progression is of fundamental importance to defining the natural history of rotator cuff disease. Identification of tear-related risk factors that correlate with arthropathy progression may help focus preventive treatment and direct appropriate counseling of the patient regarding the potential need for shoulder arthroplasty. The purpose of this study was to determine the rate of progression of RCTA in a cohort of subjects with an asymptomatic rotator cuff tear and to analyze factors associated with arthropathy progression.
Methods
The subjects included in the study are part of a larger cohort of patients with asymptomatic rotator cuff tears who presented for evaluation of shoulder pain secondary to rotator cuff disease in the contralateral shoulder.12,16 Control subjects with ultrasound scans demonstrating a normal rotator cuff in the study shoulder and a painful rotator cuff tear in the contralateral shoulder were also enrolled. Inclusion criteria for study subjects were (1) bilateral shoulder ultrasonography performed to investigate unilateral rotator cuff–based pain, (2) painful rotator cuff disease in the symptomatic shoulder, (3) a rotator cuff tear in the asymptomatic shoulder at the time of study enrollment, (4) no history of trauma to either shoulder and no traumatic episode through the study period, and (5) a minimum of 5 years of radiographic follow-up. Exclusion criteria were (1) any past or current pain in the “asymptomatic” shoulder at the time of enrollment, (2) continuous use of narcotic or nonsteroidal anti-inflammatory drugs in the 3 months before enrollment, (3) a traumatic episode affecting the symptomatic shoulder, (4) inflammatory arthritis, (5) radiographic evidence of osteoarthritis in the asymptomatic shoulder at the time of enrollment, (6) upper extremity weight-bearing demands, and (7) a subscapularis tendon tear in the asymptomatic shoulder.
Study protocol
Subjects were enrolled from the clinical practices of 3 surgeons during a 30-month period. The study protocol has been described in depth in previous studies.12,16 In brief, a trained research nurse performed annual standardized physical examinations with measurement of active range of motion and isometric strength. Patients completed standardized outcome scores including a visual analog scale for pain, the American Shoulder and Elbow Surgeons score, and the Simple Shoulder Test. Patients were specifically questioned about pain at each visits and asked to contact the study coordinator if they developed any new onset shoulder pain. Subjects also underwent standardized annual ultrasound examinations to describe tear width, length, type, fatty atrophy, and enlargement as previously defined.12 Shoulder ultrasonography, as previously described,14,16,29 was performed for each shoulder at baseline and annually thereafter. Sonographic data used for this study included baseline, 5-year, and final follow-up data. Tear enlargement was defined as increase in tear width or length of ≥5 mm from baseline values for full-thickness tears only.
Radiographic analysis
Radiographs were standardized as previously described13 by specifically selected and trained technicians. Radiographs were saved in the picture archiving and communication system (Siemens, Munich, Germany). Baseline, 5-year, and final follow-up radiographs were analyzed. Our radiology department then randomized and anonymized both the initial and final follow-up radiographs to eliminate bias. These images were then exported into the raw Digital Imaging and Communications in Medicine (DICOM) format. Each radiograph was then evaluated in this anonymized and randomized fashion by 3 independent observers (2 fellows [P.N.C. and D.H.S.] and one attending surgeon [J.D.K.]) in a DICOM viewer (OsiriX; Pixmeo, Geneva, Switzerland).
Each radiograph was graded using the Hamada classification of RCTA.10 Each radiograph was also graded using the Samilson and Prieto (SPO) classification of glenohumeral osteoarthritis.22 This classification has been demonstrated to be reliable.4 Acromiohumeral interval (AHI) was also measured on each true anteroposterior radiograph. The radiograph was performed with the shoulder in slight abduction and neutral rotated but was not fluoroscopically controlled. This distance was defined as the shortest measurable distance between the sclerotic line of the undersurface of the acromion and the superior humeral head articular surface. In those cases in which a traction enthesophyte at the origin of the coracoacromial ligament could be visualized on the scapular Y view, all attempts were made to measure from the native acromion with this enthesophyte excluded. AHI has been demonstrated to have an acceptable if imperfect interobserver reliability.2,18,24,30
Statistical analysis
For SPO and Hamada scores, interobserver reliability was calculated using weighted κ values, and consensus scores were used in the analysis. For AHI, interobserver reliability was calculated using intraclass correlation coefficients, and mean values were used in the analysis. Radiographs were divided into baseline (visit 1), 5-year follow-up (visit 2), and most recent follow-up (visit 3). Progression in SPO and Hamada scores over time was statistically compared using generalized estimating equations with a multinomial distribution, a cumulative logit link function, and an independent correlation structure; progression in AHI was analyzed using a mixed model repeated-measures analysis of variance with a heterogeneous autoregressive covariance structure. Using similar models, progression was compared between tear types (for SPO and Hamada grades) and between tears that do and do not enlarge (for SPO grade, Hamada grade, and AHI), in which the focus was on the interaction between visit and tear type and between visit and tear enlargement, respectively. Before the interaction analyses, Hamada category was dichotomized (Hamada 1 vs. Hamada > 1) because of nonunique infinite estimates. Statistical contrasts within the generalized estimating equations and repeated-measures analysis of variance models were used for specific pairwise comparisons and are Šidák adjusted. The Wilcoxon 2-sample test was used to compare tear severity by dichotomized Hamada category. The association of baseline tear length and width with change in SPO and Hamada grades was assessed with Spearman correlations. Spearman correlations also assessed the association between change in tear size and change in SPO grade, Hamada grade, and AHI.
Results
There were 138 patients who met inclusion criteria, with a total of 397 radiographs evaluated. Interobserver agreement was excellent. For SPO scores, weighted κ was 0.68 (95% confidence interval, 0.63–0.72). For Hamada scores, weighted κ was 0.72 (0.67–0.78). For AHI, intraclass correlation co-efficient was 0.88 (0.86–0.90). Of the included patients, 24% were control patients, 28% had partial-thickness tears at baseline, and 49% had full-thickness tears at baseline. Final radiographic follow-up occurred at median of 8 years (range, 5.9–12 years). Our cohort mostly included patients with small to medium-size tears. Baseline tear size for partial-thickness tears was 7.1 mm (interquartile range, 2.8) in length and 8.9 mm (2.7) in width, and final tear size was 12.7 mm (7.9) in length and 12.5 mm (8.5) in width. Baseline tear size for full-thickness tears was 13.2 mm (8.3) in length and 12.4 mm (7.2) in width, and final tear size was 21.9 mm (9.5) in length and 18.9 mm (9.4) in width.
SPO grade, Hamada grade, and AHI all progressed during the initial 5 years of the study period but not between the 5-year and most recent follow-up visits. Within SPO grades, whereas 87% of patients were grade 0 at visit 1, only 70% were by visit 3. SPO grade significantly progressed from visit 1 to 2 and visit 1 to 3 but not visit 2 to 3. Similarly, within Hamada grades, 93% were grade 1 at visit 1 whereas 77% were grade 1 at visit 3. Hamada grade significantly progressed from visit 1 to 2 and visit 1 to 3 but not visit 2 to 3. Similar to SPO and Hamada grades, AHI progressed from visit 1 to 2 and visit 1 to 3 but not visit 2 to 3 (Table I).
Table I.
Radiographic classifications for each visit (baseline, 5-year follow-up, and most recent follow-up at a median of 8 years)
| Variable | Score | Visit 1 (No. = 138) | Visit 2 (No. = 138) | Visit 3 (No. = 118) | P values for comparisons across visits |
|---|---|---|---|---|---|
|
| |||||
| SPO, No. (%) | 0 | 120 (87) | 106 (77) | 83 (70) | Overall P < .0001 |
| 1 | 18 (13) | 29 (21) | 30 (25) | Visit 1 vs. 2, P = .006 | |
| 2 | 0 (0) | 3 (2) | 4 (3) | Visit 1 vs. 3, P < .0001 | |
| 3 | 0 (0) | 0 (0) | 1 (1) | Visit 2 vs. 3, P = .23 | |
|
| |||||
| Variable | Score | Visit 1 (No. = 138) | Visit 2 (No. = 138) | Visit 3 (No. = 118) | P values for comparisons across visits |
|
| |||||
| Hamada, No. (%) | 1 | 128 (93) | 115 (83) | 91 (77) | Overall P = .0004 |
| 2 | 10 (7) | 19 (14) | 20 (17) | Visit 1 vs. 2, P = .002 | |
| 3 | 0 (0) | 4 (3) | 5 (4) | Visit 1 vs. 3, P < .0001 | |
| 4 | 0 (0) | 0 (0) | 2 (2) | Visit 2 vs. 3, P = .18 | |
|
| |||||
| Variable | Visit 1 (No. = 135) | Visit 2 (No. = 138) | Visit 3 (No. = 118) | P values for comparisons across visits | |
|
| |||||
| AHI (mm), mean (SD) | 8.9 (1.7) | 7.8 (2.2) | 7.7 (2.6) | Overall P < .0001 | |
| Visit 1 vs. 2, P < .0001 | |||||
| Visit 1 vs. 3, P < .0001 | |||||
| Visit 2 vs. 3, P = .99 | |||||
No., number of patients; SPO, Samilson-Prieto; AHI, acromiohumeral interval; SD, standard deviation.
Radiographic progression was compared with baseline tear severity. Baseline tear severity grouping (control vs. partial-thickness tear vs. full-thickness tear) did not influence SPO progression (Table II). Baseline tear severity grouping (control vs. partial-thickness tear vs. full-thickness tear) did not influence Hamada progression (Table II), but in post hoc analyses when the control group was compared with either the partial-or full-thickness tears between visits 1 and 2, progression did differ (Table II). Tear size at visits 2 and 3 was larger for shoulders with Hamada grade >1 changes compared with those with Hamada grade 1 changes in all dimensions (Table III). Change in AHI did not correlate with change in either tear width or length in any visit comparison (P >.12 in all cases).
Table II.
Comparison of change in Samilson-Prieto (SPO) and Hamada grades by baseline tear type
| Variable | Score by study baseline tear type | Visit 1 (No. = 138) | Visit 2 (No. = 138) | Visit 3 (No. = 118) | P values for comparisons across visits and study baseline tear type |
|---|---|---|---|---|---|
| SPO, No. (%) | Control | Overall P = .19 | |||
| 0 | 29 (88) | 25 (76) | 23 (85) | Control vs. partial, visit 1 to visit 2, P = .99 | |
| 1 | 4 (12) | 7 (21) | 2 (7) | Control vs. partial, visit 1 to visit 3, P = .98 | |
| 2 | 0 (0) | 1 (3) | 2 (7) | Control vs. full, visit 1 to visit 2, P = .49 | |
| Partial | Control vs. full, visit 1 to visit 3, P = .85 | ||||
| 0 | 36 (95) | 32 (84) | 24 (77) | Partial vs. full, visit 1 to visit 2, P = .46 | |
| 1 | 2 (5) | 5 (13) | 5 (16) | Partial vs. full, visit 1 to visit 3, P = .18 | |
| 2 | 0 (0) | 1 (3) | 1 (3) | ||
| 3 | 0 (0) | 0 (0) | 1 (3) | ||
| Full | |||||
| 0 | 55 (82) | 49 (73) | 36 (60) | ||
| 1 | 12 (18) | 17 (25) | 23 (38) | ||
| 2 | 0 (0) | 1 (1) | 1 (2) | ||
| Hamada, No. (%) | Control | Overall P = .09 | |||
| 1 | 29 (88) | 31 (94) | 26 (96) | Control vs. partial, visit 1 to visit 2, P = .02 | |
| 2 | 4 (12) | 2 (6) | 0 (0) | Control vs. partial, visit 1 to visit 3, P = .17 | |
| 4 | 0 (0) | 0 (0) | 1 (4) | Control vs. full, visit 1 to visit 2, P = .03 | |
| Partial | Control vs. full, visit 1 to visit 3, P = .12 | ||||
| 1 | 38 (100) | 32 (84) | 26 (84) | Partial vs. full, visit 1 to visit 2, P = .98 | |
| 2 | 0 (0) | 6 (16) | 4 (13) | Partial vs. full, visit 1 to visit 3, P = .72 | |
| 3 | 0 (0) | 0 (0) | 1 (3) | ||
| Full | |||||
| 1 | 61 (91) | 52 (78) | 39 (65) | ||
| 2 | 6 (9) | 11 (16) | 16 (27) | ||
| 3 | 0 (0) | 4 (6) | 4 (7) | ||
| 4 | 0 (0) | 0 (0) | 1 (2) | ||
No., number of patients.
Table III.
Tear characteristics at visits 2 and 3 between Hamada grade 1 and Hamada grade >1
| Variable | Visit | Statistic | Hamada score = 1 | Hamada score > 1 | P value |
|---|---|---|---|---|---|
| Tear length (mm) | Visit 2 | Median (IQR) | 10.0 (6.0) | 21.0 (16.0) | .0002 |
| No. | 91 | 21 | |||
| Visit 3 | Median (IQR) | 13.0 (11.0) | 27.0 (20.0) | .002 | |
| No. | 76 | 18 | |||
| Tear width (mm) | Visit 2 | Median (IQR) | 10.0 (7.5) | 13.5 (13.0) | .04 |
| No. | 92 | 22 | |||
| Visit 3 | Median (IQR) | 11.5 (7.0) | 23.0 (20.0) | .001 | |
| No. | 74 | 22 |
IQR, interquartile range; No., number of patients.
Tear enlargement during follow-up was not associated with radiographic progression as measured with SPO grades, Hamada grades, or AHI (P > .09 in all cases; Table IV).
Table IV.
Comparison of change in Samilson-Prieto (SPO) grade, Hamada grade, and acromiohumeral interval (AHI) by tear enlargement
| Variable | Score by enlargement ever in the study | Visit 1 (No. = 67) | Visit 2 (No. = 67) | Visit 3 (No. = 60) | P values for comparisons across visits and tear enlargement |
|---|---|---|---|---|---|
| SPO, No. (%) | No enlargement (n = 15) | Overall P = .18 | |||
| 0 | 13 (87) | 11 (73) | 6 (46) | No enlargement vs. enlargement, visit 1 to visit 2, P = .80 | |
| 1 | 2 (13) | 3 (20) | 6 (46) | ||
| 2 | 0 (0) | 1 (7) | 1 (8) | No enlargement vs. enlargement, visit 1 to visit 3, P = .16 | |
| Enlargement (n = 52) | |||||
| 0 | 42 (81) | 38 (73) | 30 (64) | ||
| 1 | 10 (19) | 14 (27) | 17 (36) | ||
| Hamada, No. (%) | No enlargement (n = 15) | Overall P = .57 | |||
| 1 | 12 (80) | 10 (67) | 7 (54) | No enlargement vs. enlargement, visit 1 to visit 2, P = .74 | |
| 2 | 3 (20) | 4 (27) | 5 (38) | ||
| 3 | 0 (0) | 1 (7) | 1 (8) | No enlargement vs. enlargement, visit 1 to visit 3, P = .50 | |
| Enlargement (n = 52) | |||||
| 1 | 49 (94) | 42 (81) | 32 (68) | ||
| 2 | 3 (6) | 7 (13) | 11 (23) | ||
| 3 | 0 (0) | 3 (6) | 3 (6) | ||
| 4 | 0 (0) | 0 (0) | 1 (2) | ||
| AHI (mm), mean (SD) | No enlargement (n = 15) | 8.4 (1.9) | 7.2 (2.5) | 6.9 (3.1) | Overall P = .80 |
| Enlargement (n = 52) | 8.6 (1.9) | 7.1 (2.4) | 7.1 (2.7) | No enlargement vs. enlargement, visit 1 to visit 2, P = .82 | |
| No enlargement vs. enlargement, visit 1 to visit 3, p = 1.0 |
No., number of patients; SD, standard deviation.
Discussion
No prior studies have described the natural history of RCTA or the tear-related risk factors for progression of RCTA. Identification of tear-related risk factors is critical for prevention and prognosis and may play a role in surgical indications. The purpose of this study was to determine the rate of progression of RCTA in a cohort of subjects with an asymptomatic rotator cuff tear and to analyze factors associated with arthropathy progression. Although our cohort mostly included patients with small to medium-size tears, SPO grade, Hamada grade, and AHI all progressed during the initial 5 years of the study period. Although progression in Hamada and SPO grades was not associated with baseline tear severity grouping, in post hoc analyses, full- and partial-thickness tears had more progression in Hamada grades than the control group did during the first 5 years of follow-up. Tear enlargement in full-thickness tears was not associated with radiographic progression as measured using SPO grades, Hamada grades, or AHI.
Within our cohort, during a median of 8 years of follow-up, AHI decreased from 8.9 ± 1.7 to 7.7 ± 2.6. Many previous studies have measured AHI progression. Gerber et al described a decrease in AHI from 7.4 to 4.9 mm with 10-year follow-up of 46 patients who underwent latissimus dorsi transfer for massive rotator cuff tears.8 Jost et al observed 20 patients who sustained imaging-documented structural failure after a rotator cuff repair, noting progression of proximal humeral migration between 3.2-year follow-up (8.4 mm) and 7.6-year follow-up (7.4 mm).11 Keener et al performed an in-depth analysis of risk factors for proximal humeral migration within the cohort used in this study. These authors found proximal humeral migration to be significantly greater in tears with symptoms, tears with involvement of the infraspinatus, and tears with larger size, although the last applied only to larger tears. In multivariate analysis, tear size was the strongest predictor of migration.13
Within our cohort, 17% of patients progressed from SPO grade 0 to ≥1, and 16% of patients progressed from Hamada grade 1 to ≥1; however, most patients had small or medium-size tears and minimal arthritic changes (93% Hamada grade 1 and 87% SPO grade 0) at baseline and thus may have been at low risk for arthritic progression. Patients who present with larger tears and more advanced arthritic changes may have more accelerated progression. In addition, within our cohort, more patients had full-thickness tears (48%) than partial-thickness tears (28%). Thus, these findings may be more representative of the natural history of full-thickness tear than of partial-thickness tear, which may progress more slowly. Numerous previous studies have documented progression of RCTA with time. Gerber et al followed up 46 shoulders for a minimum of 10 years after latissimus dorsi transfer for massive rotator cuff tears and found that 48% of patients progressed at least 1 SPO grade from a mean of 0.4 to 1.0 and 57% of patients progressed at least 1 Hamada grade from a mean of 1.2 to 2.0, all of which were significant.8 Jost et al followed up 20 patients with imaging-documented structural failure of a rotator cuff tear for a mean of 7.6 years, of whom only 3 patients progressed between 3.2 and 7.6 years of follow-up, with no significant increase in degeneration grade, although only the SPO system was used in this study.11 Paxton et al followed up 15 patients for a minimum of 10 years after a repair of a massive rotator cuff tear, all of whom had an imaging-documented retear, and found that 93% of patients progressed at least 1 Hamada grade, with 53% of patients having grade 3 or greater changes.21 Zumstein et al followed up 23 patients for a mean of 9.9 years after open repair of a massive rotator cuff tear, with a 57% retear rate and significant progression from a mean SPO grade 1.3 to 2.0, with 61% of patients having grade ≥2 changes.32
Progression in Hamada and SPO grades was not associated with baseline tear severity grouping; in post hoc analyses, full- and partial-thickness tears had more progression in Hamada grades than the control group did during the first 5 years of follow-up. However, progression of SPO grade, Hamada grade, and AHI was similar for tears that did and did not enlarge. No previous comparative studies have examined for a correlation between tear characteristics or clinical findings and the progression of RCTA, although noncomparative series have suggested that large, irreparable recurrent tears have rapid progression rates.21,31,32 The Hamada system is specific to RCTA and thus may be a more sensitive system than the SPO system. Overall, our results confirm these findings, suggesting that RCTA may be more rapidly progressive in patients with tears compared with those without tears.
Our study has several limitations. AHI was used to measure proximal humeral migration. This measurement was selected because it can be easily measured clinically and thus provides the surgeons with the most facile clinicopathologic correlate. However, it is affected by heterogeneities in patient positioning, gantry and plate positioning, humeral rotation, scapular positioning, and acromial morphology, all of which may limit reliability.2,9,18,30 Although prior studies have described low interobserver reliability with this measure, within our data set, interobserver reliability was high, probably because a standardized protocol was used for all radiographs to mitigate these effects. Similarly, both the SPO and Hamada systems provide an incomplete understanding of the extent of degenerative changes with poor resolution, although both have been extensively used within the literature. Several other classification systems exist for RCTA, and our findings may not apply to those systems. Some patients were excluded from our study because of incomplete or inadequate radiographs. Ultrasonography is user dependent and was used to measure rotator cuff tear progression, although this technique has been demonstrated to be highly accurate at our institution.27,28 In addition, this study provides only midterm (8-year) follow-up. RCTA is expected to be slowly progressive, and thus longer term follow-up will be necessary to further examine the relationship between initial tear severity and tear progression and the progression of RCTA. We did not examine for any connection between progression of arthritic changes and the patient’s symptoms. Finally, because of the relatively small tear size and lack of arthritic changes at baseline within our cohort, these patients may have been at a relatively low risk for arthritic progression, which limits the generalizability of our findings. Studies with cohorts of larger tears with longer follow-up will be necessary to determine if other rotator cuff tear–related risk factors for arthropathy progression can be found.
Conclusion
Glenohumeral arthritic changes progress significantly but remain minimal within an 8-year period in early to moderate degenerative cuff disease. Whereas the presence of a rotator cuff tear influences progression in Hamada grade, the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points.
Footnotes
The work for this manuscript was performed at Washington University Medical Center, St. Louis, MO, USA.
This study was approved by our Institutional Review Board under protocol No. 201103230.
Disclaimer
This work was supported by a grant from the National Institutes of Health (R01 AR051026).
Jay D. Keener is a paid consultant for Arthrex, serves on the editorial board for the Journal of Shoulder and Elbow Surgery, receives research support from the National Institutes of Health and Zimmer, and receives royalties from Genesis.
Aaron M. Chamberlain receives research support from Zimmer-Biomet and is a paid consultant for Arthrex.
Ken Yamaguchi receives royalties from Tornier and Zimmer.
The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
References
- 1.Bell S, Lim Y-J, Coghlan J. Long-term longitudinal follow-up of mini-open rotator cuff repair. J Bone Joint Surg Am. 2013;95:151–7. doi: 10.2106/JBJS.K.00499. http://dx.doi.org/10.2106/JBJS.K.00499. [DOI] [PubMed] [Google Scholar]
- 2.Bernhardt GA, Glehr M, Zacherl M, Wurnig C, Gruber G. Observer variability in the assessment of the acromiohumeral interval using anteroposterior shoulder radiographs. Eur J Orthop Surg Traumatol. 2013;23:185–90. doi: 10.1007/s00590-012-0942-y. http://dx.doi.org/10.1007/s00590-012-0942-y. [DOI] [PubMed] [Google Scholar]
- 3.Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM. Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am. 2001;83-A:71–7. doi: 10.2106/00004623-200101000-00010. [DOI] [PubMed] [Google Scholar]
- 4.Elsharkawi M, Cakir B, Reichel H, Kappe T. Reliability of radiologic glenohumeral osteoarthritis classifications. J Shoulder Elbow Surg. 2013;22:1063–7. doi: 10.1016/j.jse.2012.11.007. http://dx.doi.org/10.1016/j.jse.2012.11.007. [DOI] [PubMed] [Google Scholar]
- 5.Flatow EL, Harrison AK. A history of reverse total shoulder arthroplasty. Clin Orthop Relat Res. 2011;469:2432–9. doi: 10.1007/s11999-010-1733-6. http://dx.doi.org/10.1007/s11999-010-1733-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M. The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87:1697–705. doi: 10.2106/JBJS.D.02813. http://dx.doi.org/10.2106/JBJS.D.02813. [DOI] [PubMed] [Google Scholar]
- 7.Galatz LM, Griggs S, Cameron BD, Iannotti JP. Prospective longitudinal analysis of postoperative shoulder function: a ten-year follow-up study of full-thickness rotator cuff tears. J Bone Joint Surg Am. 2001;83-A:1052–6. [PubMed] [Google Scholar]
- 8.Gerber C, Rahm SA, Catanzaro S, Farshad M, Moor BK. Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years. J Bone Joint Surg Am. 2013;95:1920–6. doi: 10.2106/JBJS.M.00122. http://dx.doi.org/10.2106/JBJS.M.00122. [DOI] [PubMed] [Google Scholar]
- 9.Giphart JE, van der Meijden OAJ, Millett PJ. The effects of arm elevation on the 3-dimensional acromiohumeral distance: a biplane fluoroscopy study with normative data. J Shoulder Elbow Surg. 2012;21:1593–600. doi: 10.1016/j.jse.2011.11.023. http://dx.doi.org/10.1016/j.jse.2011.11.023. [DOI] [PubMed] [Google Scholar]
- 10.Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res. 1990;254:92–6. [PubMed] [Google Scholar]
- 11.Jost B, Zumstein M, Pfirrmann CWA, Gerber C. Long-term outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2006;88:472–9. doi: 10.2106/JBJS.E.00003. http://dx.doi.org/10.2106/JBJS.E.00003. [DOI] [PubMed] [Google Scholar]
- 12.Keener JD, Galatz LM, Teefey SA, Middleton WD, Steger-May K, Stobbs-Cucchi G, et al. A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Joint Surg Am. 2015;97:89–98. doi: 10.2106/JBJS.N.00099. http://dx.doi.org/10.2106/JBJS.N.00099. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Keener JD, Wei AS, Kim HM, Steger-May K, Yamaguchi K. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. J Bone Joint Surg Am. 2009;91:1405–13. doi: 10.2106/JBJS.H.00854. http://dx.doi.org/10.2106/JBJS.H.00854. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Kim HM, Dahiya N, Teefey SA, Middleton WD, Stobbs G, Steger-May K, et al. Location and initiation of degenerative rotator cuff tears: an analysis of three hundred and sixty shoulders. J Bone Joint Surg Am. 2010;92:1088–96. doi: 10.2106/JBJS.I.00686. http://dx.doi.org/10.2106/JBJS.I.00686. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;93:2249–54. doi: 10.2106/JBJS.J.01994. http://dx.doi.org/10.2106/JBJS.J.01994. [DOI] [PubMed] [Google Scholar]
- 16.Mall NA, Kim HM, Keener JD, Steger-May K, Teefey SA, Middleton WD, et al. Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. J Bone Joint Surg Am. 2010;92:2623–33. doi: 10.2106/JBJS.I.00506. http://dx.doi.org/10.2106/JBJS.I.00506. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Maman E, Harris C, White L, Tomlinson G, Shashank M, Boynton E. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Joint Surg Am. 2009;91:1898–906. doi: 10.2106/JBJS.G.01335. http://dx.doi.org/10.2106/JBJS.G.01335. [DOI] [PubMed] [Google Scholar]
- 18.McCreesh KM, Crotty JM, Lewis JS. Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method? A systematic review. Br J Sports Med. 2015;49:298–305. doi: 10.1136/bjsports-2012-092063. http://dx.doi.org/10.1136/bjsports-2012-092063. [DOI] [PubMed] [Google Scholar]
- 19.Moosmayer S, Tariq R, Stiris M, Smith H-J. The natural history of asymptomatic rotator cuff tears: a three-year follow-up of fifty cases. J Bone Joint Surg Am. 2013;95:1249–55. doi: 10.2106/JBJS.L.00185. http://dx.doi.org/10.2106/JBJS.L.00185. [DOI] [PubMed] [Google Scholar]
- 20.Neer CS, Craig EV, Fukuda H. Cuff-tear arthropathy. J Bone Joint Surg Am. 1983;65:1232–44. [PubMed] [Google Scholar]
- 21.Paxton ES, Teefey SA, Dahiya N, Keener JD, Yamaguchi K, Galatz LM. Clinical and radiographic outcomes of failed repairs of large or massive rotator cuff tears: minimum ten-year follow-up. J Bone Joint Surg Am. 2013;95:627–32. doi: 10.2106/JBJS.L.00255. http://dx.doi.org/10.2106/JBJS.L.00255. [DOI] [PubMed] [Google Scholar]
- 22.Samilson R, Prieto V. Dislocation arthropathy of the shoulder. J Bone Joint Surg Am. 1983;65:456. [PubMed] [Google Scholar]
- 23.Saraswat MK, Styles-Tripp F, Beaupre LA, Luciak-Corea C, Otto D, Lalani A, et al. Functional outcomes and health-related quality of life after surgical repair of full-thickness rotator cuff tears using a mini-open technique: a concise 10-year follow-up of a previous report. Am J Sports Med. 2015;43:2794–9. doi: 10.1177/0363546515602017. http://dx.doi.org/10.1177/0363546515602017. [DOI] [PubMed] [Google Scholar]
- 24.Saupe N, Pfirrmann CWA, Schmid MR, Jost B, Werner CML, Zanetti M. Association between rotator cuff abnormalities and reduced acromiohumeral distance. AJR Am J Roentgenol. 2006;187:376–82. doi: 10.2214/AJR.05.0435. http://dx.doi.org/10.2214/AJR.05.0435. [DOI] [PubMed] [Google Scholar]
- 25.Singh JA, Ramachandran R. Age-related differences in the use of total shoulder arthroplasty over time: use and outcomes. Bone Joint J. 2015;97-B:1385–9. doi: 10.1302/0301-620X.97B10.35696. http://dx.doi.org/10.1302/0301-620X.97B10.35696. [DOI] [PubMed] [Google Scholar]
- 26.Spennacchio P, Banfi G, Cucchi D, D’Ambrosi R, Cabitza P, Randelli P. Long-term outcome after arthroscopic rotator cuff treatment. Knee Surg Sports Traumatol Arthrosc. 2015;23:523–9. doi: 10.1007/s00167-014-3234-8. http://dx.doi.org/10.1007/s00167-014-3234-8. [DOI] [PubMed] [Google Scholar]
- 27.Teefey SA, Hasan SA, Middleton WD, Patel M, Wright RW, Yamaguchi K. Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am. 2000;82:498–504. [PubMed] [Google Scholar]
- 28.Teefey SA, Middleton WD, Bauer GS, Hildebolt CF, Yamaguchi K. Sonographic differences in the appearance of acute and chronic full-thickness rotator cuff tears. J Ultrasound Med. 2000;19:377–8. doi: 10.7863/jum.2000.19.6.377. quiz 383. [DOI] [PubMed] [Google Scholar]
- 29.Wall LB, Teefey SA, Middleton WD, Dahiya N, Steger-May K, Kim HM, et al. Diagnostic performance and reliability of ultrasonography for fatty degeneration of the rotator cuff muscles. J Bone Joint Surg Am. 2012;94:e83. doi: 10.2106/JBJS.J.01899. http://dx.doi.org/10.2106/JBJS.J.01899. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Werner CML, Conrad SJ, Meyer DC, Keller A, Hodler J, Gerber C. Intermethod agreement and interobserver correlation of radiologic acromiohumeral distance measurements. J Shoulder Elbow Surg. 2008;17:237–40. doi: 10.1016/j.jse.2007.06.002. http://dx.doi.org/10.1016/j.jse.2007.06.002. [DOI] [PubMed] [Google Scholar]
- 31.Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CWA, Gerber C. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg Am. 2007;89:1928–34. doi: 10.2106/JBJS.F.01073. http://dx.doi.org/10.2106/JBJS.F.01073. [DOI] [PubMed] [Google Scholar]
- 32.Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2008;90:2423–31. doi: 10.2106/JBJS.G.00677. http://dx.doi.org/10.2106/JBJS.G.00677. [DOI] [PubMed] [Google Scholar]