Treatment of non-traumatic rotator cuff tears

Abstract

We have compared three different methods of treating symptomatic non-traumatic tears of the supraspinatus tendon in patients above 55 years of age. A total of 180 shoulders (173 patients) with supraspinatus tendon tears were randomly allocated into one of three groups (each of 60 shoulders); physiotherapy (group 1), acromioplasty and physiotherapy (group 2) and rotator cuff repair, acromioplasty and physiotherapy (group 3). The Constant score was assessed and followed up by an independent observer pre-operatively and at three, six and twelve months after the intervention. Of these, 167 shoulders were available for assessment at one year (follow-up rate of 92.8%). There were 55 shoulders in group 1 (24 in males and 31 in females, mean age 65 years (55 to 79)), 57 in group 2 (29 male and 28 female, mean age 65 years (55 to 79)) and 55 shoulders in group 3 (26 male and 29 female, mean age 65 years (55 to 81)). There were no between-group differences in the Constant score at final follow-up: 74.1 (sd 14.2), 77.2 (sd 13.0) and 77.9 (sd 12.1) in groups 1, 2 and 3, respectively (p = 0.34). The mean change in the Constant score was 17.0, 17.5, and 19.8, respectively (p = 0.34). These results suggest that at one-year follow-up, operative treatment is no better than conservative treatment with regard to non-traumatic supraspinatus tears, and that conservative treatment should be considered as the primary method of treatment for this condition.

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

“…It would appear that, in this trial, patients were being advised to have surgery after a much shorter duration of symptoms and after a less comprehensive course of conservative therapies than is the case in the UK. In the Kukkonen et al 59 study of small and medium tears the duration of symptoms was similar to that in this study at 26-28 months. Only 103 out of 167 (61.7%) had previously received conservative treatment in the form of cortisone injections.…”

“…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%.…”

“…Of the two completed RCTs, one 59 was a multicentre study and both were relatively small, ranging from 103 to 173 participants per trial, with a participant age of between 60 and 65 years. One RCT 59 was a three-arm trial comparing open surgical repair, acromioplasty and physiotherapy with acromioplasty and physiotherapy and physiotherapy alone. This trial found no statistically significant difference between the interventions being compared at 1 year based on the Constant shoulder score.…”

Strength, ROM, and ultrasound-detected healing rate after arthroscopic rotator cuff repair

“…Kukkonen et al [20] and Tan et al [15] had similar findings in recent investigations: good to excellent postoperative results regardless of tear etiology [15,20]. Another recent study by Braune et al found better postoperative results in patients with acute tears than in patients with degenerative RCLs [6].…”

“…Acute, traumatic tears and tears caused by degenerative changes are often discriminated by the presence or absence of a traumatic event in the patient's medical history [1,15,20]. Tan et al [15] and Kukkonen et al [20] both searched retrospectively for a specific initiating event in the patient's history and then defined the tears as "acute" or "traumatic" regardless of the duration of symptoms. In the present study these data were collected prospectively and surgical treatment was performed within a well-defined interval of 6 weeks after the assumed trauma.…”