BACKGROUND A prospective cohort study was conducted to assess the predictors of failure of nonoperative treatment, defined as the patient undergoing surgery for symptomatic, atraumatic full-thickness rotator cuff tears. We present the 10-year follow-up data of this population to determine if predictors for surgery change over time, and secondarily we report the outcomes of the cohort. METHODS At the time of enrollment, demographic, symptom, rotator cuff anatomy, and patient-reported outcome data were collected in patients with symptomatic, atraumatic full-thickness rotator cuff tears. Patients underwent a standard physical therapy protocol for 6 to 12 weeks. Patient data were then collected at 1, 2, 5, 7, and 10 years. Failure of nonoperative treatment was defined as the patient electing to undergo surgery. RESULTS Of the 452 patients in the original cohort, 20 patients (5%) withdrew from the study, 37 (9%) died before 10 years, and 40 (9%) were otherwise lost to follow-up. A total of 115 patients (27.0%) underwent a surgical procedure at some point during the 10-year follow-up period. Of these patients, 56.5% underwent surgery within 6 months of enrollment and 43.5%, between 6 months and 10 years. Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery. Workers' Compensation status and activity level were more important predictors of later surgery. Patient-reported outcome measures all improved following physical therapy. For patients who did not undergo a surgical procedure, patient-reported outcome measures did not decline over the 10-year follow-up period. CONCLUSIONS Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery, whereas Workers' Compensation status and activity level were predictors of later surgery. Physical therapy was successful in >70% of patients with symptomatic, atraumatic full-thickness rotator cuff tears at 10 years. Outcome measures improved with physical therapy and did not decline over the 10-year follow-up period. LEVEL OF EVIDENCE Prognostic Level I . See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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有症状、无创伤性全层肩袖撕裂手术的预测因子随时间变化：MOON 肩部前瞻性队列的十年结果。


背景 进行了一项前瞻性队列研究以评估非手术治疗失败的预测因素，非手术治疗定义为因有症状、无创伤性全层肩袖撕裂而接受手术的患者。我们提供了该人群的 10 年随访数据，以确定手术的预测因子是否随时间而变化，其次，我们报告了队列的结果。方法 在入组时，收集有症状、无创伤性全层肩袖撕裂患者的人口统计学、症状、肩袖解剖结构和患者报告的结果数据。患者接受了 6 至 12 周的标准物理治疗方案。然后在 1 、 2 、 5 、 7 和 10 年时收集患者数据。非手术治疗失败定义为患者选择接受手术。结果 在原始队列的 452 名患者中，20 名患者 （5%） 退出研究，37 名 （9%） 在 10 年前死亡，40 名 （9%） 因其他原因失访。共有 115 名患者 （27.0%） 在 10 年随访期间的某个时间点接受了外科手术。在这些患者中，56.5% 在入组后 6 个月内接受了手术，43.5% 在 6 个月至 10 年之间接受了手术。研究发现，患者对物理治疗疗效的低期望是早期手术的预测指标。工伤赔偿状况和活动水平是以后手术的更重要预测因素。物理治疗后患者报告的结局指标均有所改善。对于未接受外科手术的患者，患者报告的结局指标在 10 年随访期间没有下降。 结论 发现患者对物理治疗疗效的低期望是早期手术的预测因素，而工伤赔偿状态和活动水平是后期手术的预测因素。物理治疗在 >70% 的有症状、无创伤全层肩袖撕裂患者中成功 10 年。结果指标在物理治疗后有所改善，并且在 10 年随访期间没有下降。证据水平 预后 I 级 .有关证据级别的完整描述，请参阅作者说明。