Surgical, nonoperative treatment of rotator cuff tears yielded similar outcomes
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Published results showed no significant differences in clinical outcomes at 12 months among patients with acute traumatic rotator cuff tears who received either surgical treatment or nonoperative treatment.
Researchers randomly assigned 58 patients with acute traumatic rotator cuff tears mainly involving the supraspinatus to receive either surgical repair (n=32) or physiotherapy (n=26). Researchers considered a group difference in the Constant-Murley score at 12-month follow-up as the primary outcome and differences in the Western Ontario Rotator Cuff index, numerical rating scale and EuroQol-5D-VAS as secondary outcomes. Retear rate, tear progression, fatty infiltration and atrophy were assessed with MRI.
Results showed a median Constant-Murley score of 83 and 78 in the repair group and physiotherapy group, respectively, with a between-group difference in medians of 4.5. Researchers also found the repair group had a Western Ontario Rotator Cuff index of 91% vs. 86% in the physiotherapy group and a between-group difference of 4.5. Researchers noted no differences in the numerical rating scale and EQ-5D-VAS between the groups. Retear occurred in 6.5% of patients in the repaired group, while 29.2% of patients in the physiotherapy group had tear progression of greater than 5 mm, according to results. – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Akin Cil, MD
Mats C. Ranebo, MD, and colleagues in a Level 1 randomized controlled trial showed that previously asymptomatic shoulders that had a traumatic supraspinatus tear that is around 1 cm in size have good results with or without mini-open rotator cuff repair after 12 months.
Traumatic tears traditionally have been more enthusiastically offered surgery as their healing rates are better compared to degenerative tears and in this study, the healing rate is 93.5% for the repaired group, which also had a better good to excellent Constant-Murley score (59% vs. 46%). Moreover, 29% of unrepaired patients have at least 5-mm increase in their tear size demonstrated by MRI at 12 months with some increase in fatty infiltration and atrophy.
Reconsidering the short-term follow-up of 1 year and more than 50% of the patients in this study having less than 1 cm tear, we need additional randomized controlled studies before we can define the proper indications for an early repair. Until then, this study helps the shoulder surgeon and the patient during a shared decision-making process whether to operate.
University of Missouri-Kansas City
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