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Nonsurgical treatment works well for chronic full-thickness rotator cuff tears
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For patients with chronic full-thickness rotator cuff tears, quality of life scores can predict treatment outcomes, and most patients will recover well without surgical intervention.
“We all know that cuff tears are common, and they affect people’s quality of life. The question is, should they be operated on?” said Nicholas G. H. Mohtadi, MD, of the faculty of kinesiology at the University of Calgary in Canada. “In our area of Canada, a lot of people are on long waiting lists to see a surgeon, let alone to have surgery.”
Mohtadi said, during a presentation at the 2010 Annual Meeting of the American Orthopaedic Society for Sports Medicine, that many patients who are referred for surgical intervention for rotator cuff tears have not received appropriate nonoperative treatment first, and many would most likely not require surgery. They tested this among a group of patients with mild to moderate full-thickness rotator cuff tears, and also looked for what factors might be predictive of nonoperative treatment outcome.
Home rehab program
The researchers prospectively recruited 50 patients who had been referred for surgery between the ages of 40 and 85 years, and who then underwent a 3-month nonoperative treatment program. First, a sports medicine physician saw each patient, followed by a visit with a physical therapist; the latter saw each patient for 2 to 4 weeks as they conducted the home-based rehabilitation program, and the surgical consultation was then conducted after 3 months.
In the total population, the mean duration of symptoms at baseline was about 2 years, and the average age was 60. The average score on the Rotator Cuff Quality of Life questionnaire was 44.
Of the 50 patients, 38 (76%) were successful with the nonoperative program, meaning they declined surgery after the program. The other 12 were deemed failures because they either elected to undergo surgery or did not experience adequate improvement but still declined surgery for other reasons.
Scores predict outcome
Successful patients had a mean baseline Rotator Cuff Quality of Life questionnaire score of 49/100 compared with 31/100 for failures. The scores were found to be significant predictors of outcome (P=.017). No other factors were significant predictors, but patient age and dominant extremity involvement trended toward significance.
“We now have a way of predicting outcome using the RCQOL questionnaire, and most patients are successfully treated nonsurgically,” Mohtadi said. He did note some limitations of the study including its small size and that the rotator cuff tears were of small or moderate size. In the future, he added, his group will follow the patients for longer periods of time and work with larger tears as well. – by Dave Levitan
Reference:
- Mohtadi NGH. Predicting patient outcome of non-operative treatment for a chronic rotator cuff tear. Presented at the 2010 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 15-18. Providence, R.I.
- Nicholas G. H. Mohtadi, MD, can be reached at 403-220-8272; e-mail: mohtadi@ucalgary.ca.
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