At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears

Abstract

Background: Tendon repair and physiotherapy are frequently used treatment methods for small and medium-sized rotator cuff tears. In 2 previous publications of the 1 and 5-year results of this study, we reported significant but small between-group differences in favor of tendon repair. Long-term results are needed to assess whether the results in both groups remain stable over time. Methods: In this study, 103 patients with a rotator cuff tear not exceeding 3 cm were randomly assigned to primary tendon repair or physiotherapy with optional secondary repair. Blinded follow-up was performed after 6 months and 1, 2, 5, and 10 years. Outcome measures included the Constant score; the self-report section of the American Shoulder and Elbow Surgeons score; the measurement of shoulder pain, motion, and strength; and patient satisfaction. Magnetic resonance imaging (MRI) was performed on surgically treated shoulders after 1 year, and ultrasound was performed on all shoulders after 5 and 10 years. The main analysis was by 1-way analysis of covariance and by intention to treat. Results: Ninety-one of 103 patients attended the last follow-up. After 10 years, the results were better for primary tendon repair, by 9.6 points on the Constant score (p = 0.002), 15.7 points on the American Shoulder and Elbow Surgeons score (p < 0.001), 1.8 cm on a 10-cm visual analog scale for pain (p < 0.001), 19.6° for pain-free abduction (p = 0.007), and 14.3° for pain-free flexion (p = 0.01). Fourteen patients had crossed over from physiotherapy to secondary surgery and had an outcome on the Constant score that was 10.0 points inferior compared with that of the primary tendon repair group (p = 0.03). Conclusions: At 10 years, the differences in outcome between primary tendon repair and physiotherapy for small and medium-sized rotator cuff tears had increased, with better results for primary tendon repair. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

It is not ‘business as usual’ for orthopaedic surgeons in May 2020– the Austrian-German-Swiss experience

“…It may also be speculated that the delay in orthopaedic surgical procedures may even lead to poorer postoperative outcomes. With this in view, Mossmayer et al prospectively followed 103 patients with rotator cuff tears over ten years and found that those with delayed repair had significantly poorer results than those who underwent early repair - an effect that worsened with every passing year [ 15 ]. The same was also studied in patients waiting for ACLR [ 16 ].…”

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

“…Only a well-performed prospective randomised study with long follow-up can overcome some of these difficulties. Ten year results with 88 % follow-up from such a study were recently published by Moosmayer et al 198 . The repair group had a better result for Constant score (by 9.6 points), as well as better scores for ASES, pain, pain-free abduction and pain-free flexion, with all differences being statistically significant.…”

Disorders of the Upper Extremity

“…Within that population patient outcomes following acute surgical intervention have been shown to be improved. Of note, recent data does suggest that even patients exhibiting small tears may have improved functional outcomes following surgical intervention [14].…”