Surgical Versus Nonsurgical Management of Rotator Cuff Tears

Abstract

Background: Rotator cuff disease is a major medical and economic burden due to a growing aging population, but management of rotator cuff tears remains controversial. We hypothesized that there is no difference in outcomes between patients who undergo rotator cuff repair and matched patients treated nonoperatively. Methods: After institutional review board approval, a prospective cohort of patients over 18 years of age who had a full-thickness rotator cuff tear seen on magnetic resonance imaging (MRI) were retrospectively evaluated. After clinical evaluation, each patient elected to undergo either rotator cuff repair or nonsurgical treatment. Demographic information was collected at enrollment, and self-reported outcome measures (the Normalized Western Ontario Rotator Cuff Index [WORCnorm], American Shoulder and Elbow Surgeons score [ASES], Single Assessment Numerical Evaluation [SANE], and pain score on a visual analog scale [VAS]) were collected at baseline and at 6, 12, and >24 months. The Functional Comorbidity Index (FCI) was used to assess health status at enrollment. The size and degree of atrophy of the rotator cuff tear were classified on MRI. Propensity score analysis was used to create rotator cuff repair and nonsurgical groups matched by age, sex, symptom duration, FCI, tear size, injury mechanism, and atrophy. The Student t test, chi-square test, and regression analysis were used to compare the treatment groups. Results: One hundred and seven patients in each group were available for analysis after propensity score matching. There were no differences between the groups with regard to demographics or rotator cuff tear characteristics. For all outcome measures at the time of final follow-up, the rotator cuff repair group had significantly better outcomes than the nonsurgical treatment group (p < 0.001). At the time of final follow-up, the mean outcome scores (and 95% confidence interval) for the surgical repair and nonsurgical treatment groups were, respectively, 81.4 (76.9, 85.9) and 68.8 (63.7, 74.0) for the WORCnorm, 86.1 (82.4, 90.3) and 76.2 (72.4, 80.9) for the ASES, 77.5 (70.6, 82.5) and 66.9 (61.0, 72.2) for the SANE, and 14.4 (10.2, 20.2) and 27.8 (22.5, 33.5) for the pain VAS. In the longitudinal regression analysis, better outcomes were independently associated with younger age, shorter symptom duration, and rotator cuff repair. Conclusions: Patients with a full-thickness rotator cuff tear reported improvement in pain and functional outcome scores with nonoperative treatment or surgical repair. However, patients who were offered and chose rotator cuff repair reported greater improvement in outcome scores and reduced pain compared with those who chose nonoperative treatment. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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

“…This is not surprising, since trials like that are time-and resource consuming. One attempt to overcome these problems was recently published by Ramme et al 229 . They compared 107 patients, who had chosen operative cuff repair, with 107 patients who had chosen nonsurgical treatment, matching the 2 groups with propensity score analysis regarding age, sex, symptom duration, comorbidity, tear size, injury mechanism and atrophy.…”

Comparison of the effectiveness of subacromial administration of platelet-rich plasma and hyaluronic acid in chronic shoulder pain caused by damage to the tendons of the rotator cuff muscles according to a 6-month open clinical study

“…The severity of VAS pain decreased from 56.8±15, respectively, after 6 months. 5 Хроническая боль в области плеча (ХБОП) -распространенная патология скелетно-мышечной системы, с которой связаны значительное снижение качества жизни, ограничение профессиональной и повседневной деятельности, а также социальной активности людей преимущественно трудоспособного возраста [1][2][3]. Согласно результатам анализа 19 исследований, заболеваемость ХБОП колеблется в различных возрастных группах от 0,9 до 2,5%, а ее распространенность варьирует от 4,7 до 46,7% в течение года и от 6,7 до 66,7% в течение жизни [4].…”

“…Основной причиной ХБОП является травматическое повреждение сухожилий мышц вращающей манжеты плеча (ВМП), которое наиболее часто возникает в рамках синдрома сдавления ротаторов плеча (ССРП), а также сухожилия длинной головки бицепса, с последующим развитием воспалительных и дегенеративных изменений. При проведении магнитно-резонансной томографии (МРТ) или ультразвукового исследования (УЗИ) признаки тендинита сухожилий мышц ВМП определяются у 70-90% пациентов с ХБОП [1,2,8,9].…”

“…В последние годы среди методов терапии ХБОП, вызванной повреждением и воспалительно-дегенеративными изменениями связочного аппарата ВМП, важное место заняли локальные инъекции препаратов гиалуроновой кислоты (ГлК) и аутологичной обогащенной тромбоцитами плазмы (ОТП) [1,2,10]. Механизм действия этих средств различен, но имеет общее направление -стимуляцию естественных восстановительных процессов в пораженных структурах скелетно-мышечной системы.…”

Rotura traumática do manguito rotador: comparação dos resultados obtidos em diferentes tempos até a abordagem

“…,[36][37][38][39]65,67], traz consigo muitos riscos para a cicatrização e remodelamento do tendão, como infiltração gordurosa, atrofia muscular, retração de tendão, entre outros[10,50,54,68,69], ou até mesmo progressão da lesão com degeneração do tecido[10,39,42,70,71].Algumas das características a serem levadas em conta, além desses riscos, são idade, atividade, cronicidade da lesão, o tamanho da mesma e seu comprometimento. Algumas literaturas tentam padronizar, porém referências trazem que, por exemplo a idade não seria fator preditor de mal resultado clínico,[72][73][74] o que comprova a dificuldade do manejo dessa situação, ressaltando a importância do tratamento centrado na pessoa.…”