Features to Predict Success With Nonoperative Treatment of Patients With Rotator Cuff Tears

Rotator Cuff Tear Clinical Trial

— MOON  

Official title:

Features to Predict Success With Nonoperative Treatment of Patients With Rotator Cuff Tears

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00762580
• Other study ID #: 060109
• Status: Completed
• Start date: January 2006
• Est. completion date: January 11, 2024

Study information

• Verified date: January 2024
• Source: Vanderbilt University Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The goal of this study is to find which patients will improve with the nonsurgical treatment of physical therapy for the treatment of rotator cuff tears.

Description:

Rotator cuff tears are found in up to 40% of people over the age of 50 with the prevalence increasing with age. While most people remain asymptomatic, it is unknown why some develop symptoms. In symptomatic patients, surgical repair of a torn rotator cuff fails in 30-50% of patients, yet the majority of patients have a significant reduction pain despite failure of the repair. Nonoperative treatment has reported successful outcomes in 25-82% of patients yet it is not known which patient-related features predict success with nonoperative treatment. The general aim of this research effort is to identify patient features (historical information, physical examination findings, and MRI-based pathology) that would predict success (defined by reduction in visual analog pain scale, and patient satisfaction) with the nonoperative treatment of rotator cuff tears. The proposed study design is a prospective cohort study of patients with rotator cuff tears who will follow a standard physical therapy program derived from an evidence based medicine (EBM) systematic review of Level 1 and Level 2 studies.

Study the effect of historical information on predicting success (as determined by pain relief and patient satisfaction) of nonoperative treatment using the EBM based physical therapy program in treating patients with rotator cuff tears.

Study the effect of physical examination findings on predicting success of a nonoperative treatment using the EBM-based physical therapy program in treating patients with rotator cuff tears.

Study the effect of the severity of the rotator cuff pathology (using standardized magnetic resonance imaging protocols) on predicting success of nonoperative treatment for patients with rotator cuff tears using the EBM-based physical therapy program.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 452
• Est. completion date: January 11, 2024
• Est. primary completion date: January 11, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 100 Years

Eligibility

Inclusion Criteria:

• Patients (18-100 years of age) with MRI findings of a full-thickness rotator cuff tear

Note: Criteria to obtain a shoulder MRI to evaluate for rotator cuff tear [Appendix D]:

1. Significant weakness (= 2 points per guidelines above.)

2. ADL pain or night pain >/= 7 on VAS

3. Significant impingement (per guidelines above) + with significant symptoms for = 3 months.

Exclusion Criteria:

• Acute rotator cuff tears (generally due to a high velocity injury and symptoms of less than one month)

• Associated dislocations

• Associated fractures

• Systemic Rheumatologic disease, i.e. Rheumatoid Arthritis and Systemic Lupus Erythematosis

• Patients being treated for bilateral rotator cuff tears simultaneously

• Patients unable to complete the forms

• Pain from neck or scapula

• Previous shoulder surgery

• Glenohumeral arthritis (meets = 1 of below criteria)

• osteophytes >2mm on humeral head or glenoid

• Joint space narrowing with sclerosis or cyst formation seen on true AP or axillary radiographs;

• humeral head contacting acromion

• Adhesive capsulitis

Related Conditions & MeSH terms

• Rotator Cuff Injuries
• Rotator Cuff Tear

Locations

Country	Name	City	State
United States	Colorado University Sports Medicine	Boulder	Colorado
United States	Ohio State	Columbus	Ohio
United States	Universtiy Of Iowa	Iowa City	Iowa
United States	Shoulder and Elbow Institute, Knoxville Orthopaedic Clinic	Knoxville	Tennessee
United States	Vanderbilt Universtiy Medical Center	Nashville	Tennessee
United States	Hospital for Special Surgery	New York	New York
United States	Department of Orthopaedic Surgery, Washington Universtiy School of Medicine	Saint Louis	Missouri
United States	University of California at San Francisco	San Francisco	California
United States	Sports Medicine & Shoulder Surgery, Orthopedic Institute	Sioux Falls	South Dakota

Sponsors (10)

Lead Sponsor	Collaborator
Vanderbilt University	Arthrex, Inc., Hospital for Special Surgery, New York, Knoxville Orthopedic Clinic, Ohio State University, Sports Medicine and Shoulder Surgery Orthopedic Institute, University of California, San Francisco, University of Colorado, Denver, University of Iowa, Washington University School of Medicine

Country where clinical trial is conducted

United States, 

References & Publications (51)

Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994 Nov;(308):90-7. — View Citation

Bokor DJ, Hawkins RJ, Huckell GH, Angelo RL, Schickendantz MS. Results of nonoperative management of full-thickness tears of the rotator cuff. Clin Orthop Relat Res. 1993 Sep;(294):103-10. — View Citation

Chard MD, Hazleman R, Hazleman BL, King RH, Reiss BB. Shoulder disorders in the elderly: a community survey. Arthritis Rheum. 1991 Jun;34(6):766-9. doi: 10.1002/art.1780340619. — View Citation

Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994 Nov;47(11):1245-51. doi: 10.1016/0895-4356(94)90129-5. — View Citation

Ciepiela MD, Burkhead WZ. Classification of Rotator Cuff Tears. In: Burkhead WZ, ed. Rotator Cuff Disorders.Lippincott Williams & Wilkins, 1996.

Cohen J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement 1960;20:37-46.

Djurasovic M, Marra G, Arroyo JS, Pollock RG, Flatow EL, Bigliani LU. Revision rotator cuff repair: factors influencing results. J Bone Joint Surg Am. 2001 Dec;83(12):1849-55. doi: 10.2106/00004623-200112000-00013. — View Citation

Ejnisman B, Andreoli CV, Soares BG, Fallopa F, Peccin MS, Abdalla RJ, Cohen M. Interventions for tears of the rotator cuff in adults. Cochrane Database Syst Rev. 2004;(1):CD002758. doi: 10.1002/14651858.CD002758.pub2. — View Citation

Ellman H, Kay SP, Wirth M. Arthroscopic treatment of full-thickness rotator cuff tears: 2- to 7-year follow-up study. Arthroscopy. 1993;9(2):195-200. doi: 10.1016/s0749-8063(05)80374-3. — View Citation

Feng S, Guo S, Nobuhara K, Hashimoto J, Mimori K. Prognostic indicators for outcome following rotator cuff tear repair. J Orthop Surg (Hong Kong). 2003 Dec;11(2):110-6. doi: 10.1177/230949900301100202. — View Citation

Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004 Feb;86(2):219-24. doi: 10.2106/00004623-200402000-00002. — View Citation

Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000 Apr;82(4):505-15. doi: 10.2106/00004623-200004000-00006. — View Citation

Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003 Nov-Dec;12(6):550-4. doi: 10.1016/s1058-2746(03)00211-8. — View Citation

Habernek H, Schmid L, Frauenschuh E. Five year results of rotator cuff repair. Br J Sports Med. 1999 Dec;33(6):430-3. doi: 10.1136/bjsm.33.6.430. — View Citation

Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA 3rd. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991 Aug;73(7):982-9. — View Citation

Hattrup SJ. Rotator cuff repair: relevance of patient age. J Shoulder Elbow Surg. 1995 Mar-Apr;4(2):95-100. doi: 10.1016/s1058-2746(05)80061-8. — View Citation

Hawker G, Melfi C, Paul J, Green R, Bombardier C. Comparison of a generic (SF-36) and a disease specific (WOMAC) (Western Ontario and McMaster Universities Osteoarthritis Index) instrument in the measurement of outcomes after knee replacement surgery. J Rheumatol. 1995 Jun;22(6):1193-6. — View Citation

Iannotti JP, Bernot MP, Kuhlman JR, Kelley MJ, Williams GR. Postoperative assessment of shoulder function: a prospective study of full-thickness rotator cuff tears. J Shoulder Elbow Surg. 1996 Nov-Dec;5(6):449-57. doi: 10.1016/s1058-2746(96)80017-6. — View Citation

Irrgang JJ, Anderson AF. Development and validation of health-related quality of life measures for the knee. Clin Orthop Relat Res. 2002 Sep;(402):95-109. doi: 10.1097/00003086-200209000-00009. — View Citation

Itoi E, Tabata S. Conservative treatment of rotator cuff tears. Clin Orthop Relat Res. 1992 Feb;(275):165-73. — View Citation

Itoi E, Tabata S. Incomplete rotator cuff tears. Results of operative treatment. Clin Orthop Relat Res. 1992 Nov;(284):128-35. — View Citation

Jost B, Pfirrmann CW, Gerber C, Switzerland Z. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2000 Mar;82(3):304-14. doi: 10.2106/00004623-200003000-00002. — View Citation

Kim SH, Ha KI, Park JH, Kang JS, Oh SK, Oh I. Arthroscopic versus mini-open salvage repair of the rotator cuff tear: outcome analysis at 2 to 6 years' follow-up. Arthroscopy. 2003 Sep;19(7):746-54. doi: 10.1016/s0749-8063(03)00395-5. — View Citation

Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med. 1998 Nov-Dec;26(6):764-72. doi: 10.1177/03635465980260060501. — View Citation

Knudsen HB, Gelineck J, Sojbjerg JO, Olsen BS, Johannsen HV, Sneppen O. Functional and magnetic resonance imaging evaluation after single-tendon rotator cuff reconstruction. J Shoulder Elbow Surg. 1999 May-Jun;8(3):242-6. doi: 10.1016/s1058-2746(99)90136-2. — View Citation

Lehman C, Cuomo F, Kummer FJ, Zuckerman JD. The incidence of full thickness rotator cuff tears in a large cadaveric population. Bull Hosp Jt Dis. 1995;54(1):30-1. — View Citation

Lopez JG, Ernst MD, Wright TW. Acromioplasty: comparison of outcome in patients with and without workers' compensation. J South Orthop Assoc. 2000 Winter;9(4):262-6. — View Citation

Massoud SN, Levy O, Copeland SA. Subacromial decompression. Treatment for small- and medium-sized tears of the rotator cuff. J Bone Joint Surg Br. 2002 Sep;84(7):955-60. doi: 10.1302/0301-620x.84b7.12378. — View Citation

McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994 Jan;32(1):40-66. doi: 10.1097/00005650-199401000-00004. — View Citation

McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993 Mar;31(3):247-63. doi: 10.1097/00005650-199303000-00006. — View Citation

Motycka T, Kriegleder B, Landsiedl F. Results of open repair of the rotator cuff--a long-term review of 79 shoulders. Arch Orthop Trauma Surg. 2001;121(3):148-51. doi: 10.1007/s004020000199. — View Citation

Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972 Jan;54(1):41-50. No abstract available. — View Citation

Patel VR, Singh D, Calvert PT, Bayley JI. Arthroscopic subacromial decompression: results and factors affecting outcome. J Shoulder Elbow Surg. 1999 May-Jun;8(3):231-7. doi: 10.1016/s1058-2746(99)90134-9. — View Citation

Romeo AA, Hang DW, Bach BR Jr, Shott S. Repair of full thickness rotator cuff tears. Gender, age, and other factors affecting outcome. Clin Orthop Relat Res. 1999 Oct;(367):243-55. — View Citation

Sallay PI, Reed L. The measurement of normative American Shoulder and Elbow Surgeons scores. J Shoulder Elbow Surg. 2003 Nov-Dec;12(6):622-7. doi: 10.1016/s1058-2746(03)00209-x. — View Citation

Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-5. doi: 10.2106/00004623-199501000-00002. — View Citation

Silverstein B, Viikari-Juntura E, Kalat J. Use of a prevention index to identify industries at high risk for work-related musculoskeletal disorders of the neck, back, and upper extremity in Washington state, 1990-1998. Am J Ind Med. 2002 Mar;41(3):149-69. doi: 10.1002/ajim.10054. — View Citation

Silverstein B, Welp E, Nelson N, Kalat J. Claims incidence of work-related disorders of the upper extremities: Washington state, 1987 through 1995. Am J Public Health. 1998 Dec;88(12):1827-33. doi: 10.2105/ajph.88.12.1827. — View Citation

Small NC, Sledge CB, Katz JN. A conceptual framework for outcomes research in arthroscopic meniscectomy: results of a nominal group process. Arthroscopy. 1994 Oct;10(5):486-92. doi: 10.1016/s0749-8063(05)80002-7. — View Citation

Sonnabend DH, Watson EM. Structural factors affecting the outcome of rotator cuff repair. J Shoulder Elbow Surg. 2002 May-Jun;11(3):212-8. doi: 10.1067/mse.2002.122272. — View Citation

Spangehl MJ, Hawkins RH, McCormack RG, Loomer RL. Arthroscopic versus open acromioplasty: a prospective, randomized, blinded study. J Shoulder Elbow Surg. 2002 Mar-Apr;11(2):101-7. doi: 10.1067/mse.2002.120915. — View Citation

Stewart AL, Hays RD, Ware JE Jr. The MOS short-form general health survey. Reliability and validity in a patient population. Med Care. 1988 Jul;26(7):724-35. doi: 10.1097/00005650-198807000-00007. No abstract available. — View Citation

Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999 Jul-Aug;8(4):296-9. doi: 10.1016/s1058-2746(99)90148-9. — View Citation

Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F. Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. 1997 Nov;(344):275-83. — View Citation

Vitale MG, Krant JJ, Gelijns AC, Heitjan DF, Arons RR, Bigliani LU, Flatow EL. Geographic variations in the rates of operative procedures involving the shoulder, including total shoulder replacement, humeral head replacement, and rotator cuff repair. J Bone Joint Surg Am. 1999 Jun;81(6):763-72. doi: 10.2106/00004623-199906000-00003. — View Citation

Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473-83. — View Citation

Wolfgang GL. Surgical repair of tears of the rotator cuff of the shoulder. Factors influencing the result. J Bone Joint Surg Am. 1974 Jan;56(1):14-26. No abstract available. — View Citation

Worland RL, Arredondo J, Angles F, Lopez-Jimenez F. Repair of massive rotator cuff tears in patients older than 70 years. J Shoulder Elbow Surg. 1999 Jan-Feb;8(1):26-30. doi: 10.1016/s1058-2746(99)90050-2. — View Citation

Worland RL, Lee D, Orozco CG, SozaRex F, Keenan J. Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients. J South Orthop Assoc. 2003 Spring;12(1):23-6. — View Citation

Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001 May-Jun;10(3):199-203. doi: 10.1067/mse.2001.113086. — View Citation

Zanetti M, Jost B, Hodler J, Gerber C. MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects. Skeletal Radiol. 2000 Jun;29(6):314-9. doi: 10.1007/s002560000203. — View Citation

* Note: There are 51 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Predict successful outcome with an evidence-based, non-operative treatment program by collecting VAS Pain Scale and SANE score.		One year
Secondary	Predict success of non-operative treatment outcomes with other patient related validated instruments (SF-12, ASES, WORC, Marx Activity Scale)		One Year