Sunday, August 2, 2015

Rotator cuff surgery - why do we call it 'repair'?

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

These authors conducted a randomized controlled trial that included 56 patients with a degenerative full-thickness supraspinatus tears between January 2009 and December 2012; 31 patients were treated conservatively, and rotator cuff repair was attempted in 25 patients.

Outcome measures, including the Constant-Murley score (CMS), visual analog scale (VAS) pain and VAS disability scores, were assessed preoperatively and after 6 weeks and 3, 6, and 12 months. Magnetic resonance imaging was performed preoperatively and at 12 months postoperatively.

In the surgery group, the retear rate was 74 % by MRI (14 retears out of the 19 for which MRI's were available).

At 12 months postoperatively, the mean CMS was not significantly different between the surgery group and the non-operative group.
VAS pain and VAS disability were significantly lower in the surgery group at the 12-month follow-up. The four operated shoulders with intact repairs had the best CMS results.

Comment: This paper reminds us of the one on which we posted recently here. Healing does not appear to be routine after attempted rotator cuff repair.

The graph below was of particular interest
 It emphasizes the disability imposed by a cuff repair attempt for the first 20 weeks after surgery. The drop in CMS after surgery did not occur with non-operative management. While the 'intact' shoulders did better than the non-operatively treated group, we must remember that this group is comprised of only 4 out of 19 shoulders.

It is rare to see a such a randomized trial. The results in 60 year old patients with supraspinatus tears gives is something to think about before recommending a repair attempt.


Check out the new Shoulder Arthritis Book - click here.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'