Earlier intervention is an important treatment goal for the growing number of older patients at risk of atraumatic, or degenerative, rotator cuff tears (RCTs). However, today there is still much uncertainty about which patients bear the greatest risk.
“We still lack a strong profile of patients who are prone to develop atraumatic rotator cuff injuries, despite their high prevalence among older patients,” said Nitin Jain, M.D., an associate professor of physical medicine and rehabilitation and orthopaedics at Vanderbilt University Medical Center.
Jain, an expert on atraumatic RCTs, is leading several new research initiatives to inform earlier, more personalized interventions, including investigating genetic markers. The research will complement Jain’s work as principal investigator for the Vanderbilt-led Arthroscopic Rotator Cuff (ARC) trial, the largest randomized study to date of surgical versus non-surgical treatments for atraumatic RCTs. Jain also leads the multi-site ROW Study focused on RCT diagnosis.
Risk Factors for RCTs
Prior studies suggest a host of behavioral and health characteristics may contribute to risk for atraumatic RCT. In addition to age and physical labor, potential risk factors include diabetes, BMI and hypo-high-density lipoproteinemia, smoking, and alcohol use.
Jain plans to conduct the most detailed analysis yet of potential risk factors for atraumatic RCTs. This will include a large-scale review of patient data from the ARC and ROW trials, the MOON (Multicenter Orthopedic Outcomes Network) Shoulder Group, and the Vanderbilt Synthetic Derivative, the medical center’s database of de-identified electronic medical records.
“As we better understand risk factors… we can guide interventions aimed towards prophylaxis.”
This comprehensive analysis should help inform earlier interventions. “As we better understand risk factors associated with rotator cuff tears, we can guide interventions aimed towards prophylaxis in high-risk individuals,” Jain said.
A Genetic View
Jain is also exploring genetics as an avenue to proactive interventions. As yet, research on the genetic predisposition of atraumatic RCTs has been limited. “There is some preliminary evidence looking at genetics, but this type of analysis requires a massive scale,” Jain said.
Jain plans to search for potential genetic markers using several large biobanks including BioVU, Vanderbilt’s massive repository of DNA profiles linked with anonymized patient health records, and will be partnering with Ayush Giri, Ph.D., a Vanderbilt genetic epidemiologist who specializes in large-scale data analysis.
“We will be leveraging Vanderbilt’s resources, those of collaborating institutions and the United Kingdom biobank to convene the largest consortium studying the genetics of rotator cuff tears,” Jain said.
Uniting Multiple Research Arms
Jain anticipates new findings on comparative treatment outcomes (surgical versus non-surgical) from the ARC trial and ROW study within the next five years. Combined with the new research on risk factors, the result should significantly expand the knowledge base on diagnosis and treatment of atraumatic RCTs.
“We are just scraping the surface of the science.”
“We are just scraping the surface of the science to advance the field,” Jain said. “Rotator cuff tears and shoulder pain are some of the most common reasons for patients to see their doctors. Added knowledge in this area will help prevent significant morbidity, loss of productivity and the high cost of treatment to our health systems.”