In the latest 'What's New in Sports Medicine' review, the following appears regarding the article: Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a 5-year follow-up.
"Rotator Cuff Repair Compared with Therapy
Patient outcomes of primary tendon repair compared with those of physical therapy were reported from a randomized controlled trial of 103 patients with rotator cuff tears not exceeding 3 cm. Patients were followed at 6 months and at 1, 2, and 5 years with a 98% follow-up rate. Twelve of 51 patients in the physical therapy group underwent secondary rotator cuff repair. Patients in the primary repair group had significantly better group-mean improvements on the Constant score (5.3 points), American Shoulder and Elbow Surgeons score (9.0 points), visual analog scale (VAS) for pain (1.1 cm), and VAS for patient satisfaction (1.0 cm) compared with patients who underwent secondary repair. This difference may be below clinical importance. In 37% of patients treated with physical therapy only, there were increasing tear sizes on ultrasound that were >5 mm and these were associated with inferior outcomes."
The authors selected the Constant Score as the primary outcome of interest. This score was only slightly better for the group having surgical repair: 79.8 ± 15.0 as compared to 74.2 ± 20.3 for the PT group. P = .05.
The failure rates in the two groups were comparable:
(1) Over 14 of the tears treated with PT had progression of the tear size > 5mm, some related to trauma. It is not possible to know if repair of these tears would have been successful. Twelve nonoperative patients reported an insufficient treatment effect and desired surgical treatment.
The failure rates in the two groups were comparable:
(1) Over 14 of the tears treated with PT had progression of the tear size > 5mm, some related to trauma. It is not possible to know if repair of these tears would have been successful. Twelve nonoperative patients reported an insufficient treatment effect and desired surgical treatment.
(2) For the surgical patients, a re-tear (or non-healing) was diagnosed 15 patients. The recurrent defect was full-thickness in eight patients (13%) and a partial-thickness in seven patients (12%). These are essentially the same results as found in the classic article by Harryman et al reported over two decades ago. There was no mention of whether complications occurred in the surgery group. It is not stated if the re-tears required repeat surgery.
A biceps tenodesis was performed in over one third of cases in the primary tendon repair group; no biceps tenodeses were performed in the physical therapy group. Thus, if over 1/3 of patients in this series had biceps tendon pathology, this pathology went untreated in the PT group. One could wonder if such untreated pathology might have accounted for the small difference in the two outcomes.
Our approach to rotator cuff tears remains unaltered: acute tears resulting in a substantial change of shoulder function deserve strong consideration for prompt surgical repair if the patient is healthy and active as long as there is no reason to believe the tendon is of poor quantity or quality (i.e. patient is elderly, a smoker, has had steroid injections, has atrophy, massive tear, retraction).
Chronic tears deserve a good try at non operative management. If non-operative management is not successful, consideration can be given to a smooth and move or a repair depending on the quantity and quality of the tissue encountered at surgery.
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Consultation for those who live a distance away from Seattle.
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Click here to see the new Rotator Cuff Book
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Our approach to rotator cuff tears remains unaltered: acute tears resulting in a substantial change of shoulder function deserve strong consideration for prompt surgical repair if the patient is healthy and active as long as there is no reason to believe the tendon is of poor quantity or quality (i.e. patient is elderly, a smoker, has had steroid injections, has atrophy, massive tear, retraction).
Chronic tears deserve a good try at non operative management. If non-operative management is not successful, consideration can be given to a smooth and move or a repair depending on the quantity and quality of the tissue encountered at surgery.
===
Consultation for those who live a distance away from Seattle.
Click here to see the new Rotator Cuff Book
To see the topics covered in this Blog, click here
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You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
