This competitive renewal proposes to study the effect of surgical intervention to improve the natural history of degenerative rotator cuff tears by comparing disease progression risks following surgery to the defined risks of asymptomatic cuff tears we have established with longitudinal studies. Additionally, we will also focus on defining risk factors upon presentation of a painful cuff tear that may predict future symptomatic development in the contralateral shoulder. This renewal will better define the potential benefit of early surgical intervention. IIA) Specific Aim 1: To obtain long-term follow-up (minimum 8 years) of a cohort of asymptomatic rotator cuff tears in subjects aged 65 years or younger to define the risks of tear enlargement and factors related to pain development. The most clinically relevant subjects within our cohort are those that retain good potential for tendon healing with surgical intervention. Further monitoring of these subjects is needed to define the long-term risks of non-operative treatment. The debate for operative indications is most relevant for patients that retain good healing potential with surgery and cannot be answered with only 5 years follow-up. The risks of tear deterioration without surgery must be determined through a period of time until healing is not likely because of patient age. IIB) Specific Aim 2: To assess the ability of rotator cuff repair surgery to interrupt the natural progression of degenerative cuff disease. The ability of surgery to halt the natural progression of degenerative rotator cuff disease has not been characterized. Untreated full-thickness rotator cuff tears enlarge in 50% of subjects, short-term. Tear enlargement is associated with declining function and advancing muscle degeneration. The natural history for non-operatively treated rotator cuff tears is concerning, in the short-term for disease progression. Because younger age and smaller tear size have been established as good predictors of healing with surgery, many advocate early repair in this group. These potential benefits are only realized if the natural history for repaired tendons is superior. Prospectively defining the benefits of surgery in subjects with good healing potential compared to nonoperatively treated tears will better define the role of early surgery. IIC) Specific Aim 3: o determine factors predictive of contralateral symptomatic rotator cuff disease progression based on the clinical presentation of a symptomatic rotator cuff tear. Approximately 56% of subjects with a painful rotator cuff tear will have an asymptomatic tear in the contralateral shoulder. Analysis of features related to the painful shoulder that may be predictive of future pain in the asymptomatic shoulder has not been previously considered. The ability to define patient and tear-related factors in the painful shoulder that are predictive of disease progression in the asymptomatic side will identify higher risk patients. Defining these factors is fundamental for counseling patients with degenerative rotator cuff tears and provides a foundation for patient education and implementation of preventive treatment strategies.

Public Health Relevance

A painful shoulder from rotator cuff disease is one of the most common problems afflicting the musculoskeletal system with research showing that up to 50% of individuals over the age of 70 year old may have tears. Understanding what factors are important in the development of shoulder pain, loss of shoulder function and enlargement of the tear are critically important to formulate strategies for treatment. This study proposes to follow younger individuals with rotator cuff tears and no pain over an extended period of time to determine the risks of new pain and the ability of surgery to halt the natural progression of rotator cuff disease.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Skeletal Biology Structure and Regeneration Study Section (SBSR)
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Washabaugh, Charles H
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Washington University
Schools of Medicine
Saint Louis
United States
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Codding, Jason L; Keener, Jay D (2018) Natural History of Degenerative Rotator Cuff Tears. Curr Rev Musculoskelet Med 11:77-85
Keener, Jay D; Patterson, Brendan M; Orvets, Nathan et al. (2018) Degenerative Rotator Cuff Tears: Refining Surgical Indications Based on Natural History Data. J Am Acad Orthop Surg :
Chalmers, Peter N; Salazar, Dane; Steger-May, Karen et al. (2017) Does the Critical Shoulder Angle Correlate With Rotator Cuff Tear Progression? Clin Orthop Relat Res 475:1608-1617
Chalmers, Peter N; Salazar, Dane H; Steger-May, Karen et al. (2016) Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears. J Shoulder Elbow Surg 25:1749-1755
Hsu, Jason; Keener, Jay D (2015) Natural History of Rotator Cuff Disease and Implications on Management. Oper Tech Orthop 25:2-9
Keener, Jay D; Galatz, Leesa M; Teefey, Sharlene A et al. (2015) A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Joint Surg Am 97:89-98
Keener, Jay D; Hsu, Jason E; Steger-May, Karen et al. (2015) Patterns of tear progression for asymptomatic degenerative rotator cuff tears. J Shoulder Elbow Surg 24:1845-51
Jain, Nitin B; Yamaguchi, Ken (2014) The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty. J Shoulder Elbow Surg 23:1905-1912
Keener, Jay D (2013) Surveillance of conservatively treated rotator cuff tears is warranted. Commentary on an article by Stefan Moosmayer, MD, PhD, et al.: ""The natural history of asymptomatic rotator cuff tears. a three-year follow-up of fifty cases"". J Bone Joint Surg Am 95:e101 1-2
Wall, Lindley B; Teefey, Sharlene A; Middleton, William D et al. (2012) Diagnostic performance and reliability of ultrasonography for fatty degeneration of the rotator cuff muscles. J Bone Joint Surg Am 94:e83

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