Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff

Abstract

In order to compare the outcome from surgical repair and physiotherapy, 103 patients with symptomatic small and medium-sized tears of the rotator cuff were randomly allocated to one of the two approaches. The primary outcome measure was the Constant score, and secondary outcome measures included the self-report section of the American Shoulder and Elbow Surgeons score, the Short Form 36 Health Survey and subscores for shoulder movement, pain, strength and patient satisfaction. Scores were taken at baseline and after six and 12 months by a blinded assessor. Nine patients (18%) with insufficient benefit from physiotherapy after at least 15 treatment sessions underwent secondary surgical treatment. Analysis of between-group differences showed better results for the surgery group on the Constant scale (difference 13.0 points, p - 0.002), on the American Shoulder and Elbow surgeons scale (difference 16.1 points, p < 0.0005), for pain-free abduction (difference 28.8 degrees , p = 0.003) and for reduction in pain (difference on a visual analogue scale -1.7 cm, p < 0.0005).

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

“…The number of patients suffering significant complications was very low and less than the rate described by Moosmayer et al, 60 but similar to that described by Kukkonen et al 59 The infection rate in this study was 0.7% and the rate of revision surgery was 1.5%.…”

“…53 We found two further trials of surgery compared with conservative care published since the trial began. In the single-centre trial of small and medium tears by Moosmayer et al, 60 the surgical group had better outcomes at 1 year. This study reported a full-thickness re-tear rate of 8% and a partial-thickness re-tear rate of 12%.…”

Current practice in shoulder pathology: results of a web-based survey among a community of 1,084 orthopedic surgeons

“…The authors concluded that both approaches can be considered for the treatment of patients with small and medium-sized rotator cuff tears, but better results can be expected after primary surgical repair [14].…”

Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial

“…Scientific evidence is limited, because only 2 randomized controlled trials have compared the 2 modalities, and they present conflicting results. 17,24,25 A study by Kukkonen et al 17 found no difference between the treatments, and in a study by Moosmayer et al, 24 surgical repair was favorable.…”

“…Surgical repair and conservative treatment are both described, and acceptable results are reported for both. 2,6,11,17,24 Those who favor surgical repair worry that tear progression over time will lead to increased disability with conservative treatment of full-thickness tears. The rotator cuff has limited capabilities for healing without repair, 33 yet conservative treatment often yields an acceptable outcome.…”