Factors Associated With Tear Propagation and Patient-Reported Outcomes Following Personalized Exercise Therapy for Individuals With Symptomatic Rotator Cuff Tears

Background: Exercise therapy is recommended for the initial treatment of individuals with rotator cuff tears but fails in 25% to 50% of cases. Determining the baseline factors associated with patient-reported outcomes and tear propagation immediately following exercise therapy may improve treatment decision-making. Purpose: To prospectively identify factors associated with tear propagation and patient-reported outcomes immediately following a 12-week personalized exercise therapy program in individuals with symptomatic isolated supraspinatus tears. Study Design: Cohort study; Level of evidence, 2. Methods: In total, 109 individuals were recruited for this prognostic prospective longitudinal cross-sectional study and underwent a 12-week personalized exercise therapy program for the treatment of rotator cuff tears. Individuals underwent assessments of passive glenohumeral range of motion (ROM), isometric muscle strength (internal and external rotation and abduction), and glenohumeral arthrokinematics during scapular plane abduction immediately before the initiation of exercise therapy. Immediately before and after the exercise therapy program, tear size was quantified using ultrasound (propagation defined as tear size change ≥4.6 mm), and individuals completed the Western Ontario Rotator Cuff (WORC) Index score. Logistic and multiple linear regression were used to determine if baseline glenohumeral contact path length, tear size, passive glenohumeral ROM, and isometric strength were predictors of tear propagation and patient-reported outcomes immediately following exercise therapy. Results: Overall, 7 individuals (8.5%) experienced tear propagation immediately following exercise therapy. Logistic regression analysis indicated that baseline tear size was the only predictor associated with tear propagation immediately following exercise therapy. There was a 29.0% decrease in the odds of tear propagation for each 1.0-mm increase in baseline tear size (odds ratio, 0.71; 95% CI, 0.51-0.99; P = .04). Higher baseline isometric internal rotation strength predicted higher WORC scores ( P = .044). Conclusion: Immediately following a 12-week personalized exercise therapy program, the percentage of individuals who experienced tear propagation was low, and baseline tear size and higher internal rotation strength were associated with tear propagation and WORC scores, respectively. Thus, the current study identified factors immediately before exercise therapy that affect tear propagation and WORC scores following an exercise therapy program.