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Rotator Cuff Tears: What is the Best Treatment Solution?

In 2004, 103 patients with full-thickness rotator cuff tears not exceeding 3 cm were selected for a study. The researchers randomly assigned them to surgical repair or physical therapy with an optional secondary repair.

“This study presents for the first time long-term results from a comparison between tendon repair and physiotherapy in the treatment of rotator cuff tears” Stefan Moosmayer, MD, PhD, and colleagues told Healio.

Researchers conducted several follow-ups after 6 months and at 1, 2, 5 and 10 years.  Data included on research was:

  • Measurement of shoulder pain;
  • Motion and strength;
  • Patient satisfaction;
  • Constant score;
  • Self-report section of the American Shoulder and Elbow Surgeons Score (ASES).

1-year and 5-year results were inconclusive. The outcomes published in 2005 and 2010 were considered to be “possibly clinically irrelevant” by the researchers. Now, the authors report 10-year follow-up results: outcomes generally were better with surgery.

“It shows that results are more stable after tendon repair and that between-group differences increase over time. This supports the use of a primary tendon repair for small and medium-sized rotator cuff tears in younger and active patients.”

In intention-to-treat analyses, mean scores for most clinical outcomes (covering pain and function) remained significantly better in the surgery group than in the physical therapy group, with larger between-group differences than at 5 years.

Good-to-excellent results were reported by 71% of surgical patients and by 42% of physiotherapy patients. This difference suggests that one person benefited for every three or four who underwent surgery initially.

Treatment efficacy was higher for primary tendon repair at all follow-ups. At long-term follow-ups, shoulder function remained stable in the surgical group but declined in the physiotherapy group.

“It is known that unrepaired tears can widen over time and we suspect that over the 10-year study period, anatomic tear deterioration in the physiotherapy group may have led to worse outcomes” authors said.

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