Ford in Detroit. I'd like to take a moment to thank AOSSM for this opportunity to present this paper and to all my co-authors and dedication to this project. We have no relevant disclosures to this presentation. So rotator cuff tears are among the most common causes of shoulder pain and dysfunction amongst patients. And conservative management is often attempted initially, but for those who do not do well with that, the decision to pursue surgery is multifactorial. It depends on age, activity level, pain and dysfunction, and tear characteristics. Now the decision to continue with non-operative treatment is even more debated. And the success of this has really not been defined clearly in the literature. In 2019, Contre et al and AJSM showed that over a systematic review, over a 12 year period, most people are making rapid improvements, whether you're undergoing operative or a non-operative treatment. And when looking at the MCID, the minimal clinically important difference, which is the minimal difference a patient perceives as doing better, there have been very few studies looking at this for non-operatively treated rotator cuff tears. So the group out in Utah in 2009 looked at the visual analog scale for pain scores and found that only 56% of these patients were actually meeting these MCID criteria. And looking forward to compare non-operative tears, Song et al in a multi-center study showed that non-operative tears were actually more likely to achieve MCID for shoulder pain and disability index at three months, but looking out to 15 and 24 months, actually surgical group was favored. So to this date, there have been no studies that looked at MCID for patient-reported outcome measurement information system or PROMIS scores for non-operatively treated rotator cuff tears. So the purpose was to look at those patients undergoing conservative therapy, who are those ideal candidates, establish the MCID for these various PROMIS assessments. So we performed a retrospective cohort study in a single institution from 2020 to 2021, which were ultrasound and MRI-confirmed tears. And so the inclusion criteria were those undergoing conservative management, and we excluded those who underwent surgery in the index study period, and also had incomplete follow-up to six months. And we calculated the MCID using a distribution method, which was a half standard deviation method there. So here are the results. So we started off with 2,000 patients, narrowed this down to 311 patients, and ultimately had a 76% follow-up, but complete follow-up at six months. So here's our demographics table, pretty busy. But overall, we had 236 patients, mean age 62 years old, 59% female. And then when breaking down into tear types, 54% were full thickness, 46% were partial. And then breaking down those full thickness, small was 11%, medium 65, large three, massive 21. So this is the baseline to follow-up PROMIS scores of six months. And this is the combined tears here. And you can see that there were significant improvements from baseline to follow-up for PROMIS upper extremity and PROMIS pain interference. So they both were doing well. When stratifying by full thickness tears, we found similar results here, as well as for partial thickness. So all groups were making improvements over the six-month period. Now when looking at the MCID for these tears, we found that only 61%, about two-thirds, were actually reaching MCID for PROMIS upper extremity. And even lower for PROMIS pain interference, only 50% were meeting this MCID. And this was similar for full thickness and partial thickness, and there were no differences between those groups. Now next we wanted to look at what does a univariate model show us as a logistic regression to predict what are the factors leading to achieving MCID. We found that females were less likely, as well as African-Americans were actually more likely to achieve MCID for full thickness tears for PROMIS upper extremity. When looking at partial thickness tears, there were actually no other differences found in these models. So in conclusion, the majority of the patients reported improvements in the six-month study period. However, only two-thirds of patients were meeting PROMIS upper extremity MCID, and even lower at 50% for PROMIS pain interference. And in a previous study from our group, Tramer and all, we showed that after two years, rotator cuff repairs, they were achieving MCID for upper extremity 81% of the time and 65% for pain interference. So what is this discrepancy here between non-operative and operative treatment? So is this really a success that's acceptable for non-operative management? There's a couple more questions that remain to be seen looking at these patients who are being treated with therapy. These are my references. Thank you.

management of rotator cuff tears

conservative management

surgery decision

non-operative treatment

minimal clinically important difference (MCID)