Partiële schouderpeesrupturen: wel of geen operatie?

Op het jaarlijkse Amerikaanse Orthopeden congres, de grootste bijeenkomst in de ortopedische wereld met meer dan 16.000 orthopeden vanuit de gehele wereld deze maal in San Francisco aanwezig, presenteerde een Canadese groep hun visie omtrent het wel of niet opereren van de gedeeltelijk geruptureerde schouderpezen.
Uit onderstaande samenvatting blijkt dat de grens van 50% diepte van de scheur een cruciale is: grotere rupturen toonden vaker progressie naar scheuren van volledige dikte. Scheuren met een diepte minder dan 50% lieten minder progressie zien en het niet opereren leidde tot grotendeels tevreden patiënten.

Partial Thickness Rotator Cuff Tears: Observe or Operate?
Lo, MD, Matthew R. Denkers, MD, Kristie D. More, MSc, Robert Hollinshead, MD, Richard S. Boorman, MD

INTRODUCTION Despite being more common than full thickness rotator cuff tears, the treatment of partial thickness tears of the rotator cuff remains controversial. Furthermore, the majority of published literature is related to the diagnosis and operative treatment of such. Therefore, the purposes of this study were: 1) To determine baseline clinical factors predictive of successful outcome of non-operative treatment of partial thickness rotator cuff tears.; 2) To determine the mid-term clinical success rate of non-operative treatment of partial thickness rotator cuff tears.; 3) To determine the mid-term anatomic outcome of non-operative treatment of partial thickness rotator cuff tears.
METHODS All patients from the senior author’s practice between 2004 and 2006 with a primary diagnosis of a partial thickness rotator cuff tear (made via MRI/MRA) were eligible for inclusion. Patient with associated conditions, such as OA, SLAP lesion, AC joint pathology, or subscapularis tears, or patients with major medical illnesses were excluded. Patients were assessed clinically using a standardized protocol (physical exam as well as American Shoulder and Elbow Surgeons evaluation (ASES) and the Simple Shoulder Test (SST)) at baseline and follow up. Patients treated non-operatively underwent anatomic follow up utilizing MRI or MR-arthrogram imaging based on their initial imaging study. RESULTS Seventy-six patients (48 males, 28 females) with an average age of 52 +/- 10 years were included in the study. Forty-six (61%) had involvement of their dominant arm. Baseline ASES scores were 54.9/100 +/- 19.6, and baseline SST scores were 5.9/12 +/- 3.1. Thirty-seven patients (49%) underwent non-operative treatment, while 39 (51%) underwent surgical repair. Logistic regression analysis indicated that the baseline variables of side (dominant or non-dominant side involved), onset (traumatic or atraumatic) and thickness of tear (< 50% or >50%) were significant predictors of outcome. That is, patients who had dominant side involvement, traumatic onset, and a tear >50% thickness were more likely to go on to surgery, whereas patients who had involvement of their non-dominant side, atraumatic onset, and a tear <50>50% thickness on the initial imaging study demonstrated tear progression 55% of the time.
DISCUSSION AND CONCLUSION In conclusion, non-operative treatment was utilized in approximately 50% of the patients and overall 78% of patients were satisfied with their treatment. The baseline factors of onset, shoulder involved, and thickness of tear can be used to predict the optimal type of treatment. Overall, 76% of patients treated non-operatively demonstrated no tear progression, however in patients with tears >50% thickness, the tear progressed 55% of the time.