Wednesday, July 20, 2016

Rotator cuff tears - non-operative and arthroscopic management

Clinical Outcomes of Conservative Treatment and Arthroscopic Repair of Rotator Cuff Tears: A Retrospective Observational Study.

These authors conducted a retrospective study of 357 symptomatic patients aged >50 years with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear.

 183 patients received conservative treatment (various approaches including rest, PT, medication) and 174 patients received an arthroscopic repair. 

The pain assessment score (p<0.001) and the ROM in forward flexion (p<0.001) were significantly improved in both groups. The pain assessment score and ROM were not significantly different between the two groups. Retear was observed in 9.6% of patients who had an arthroscopic repair and tear progression was found in 6.7% of those who underwent conservative treatment. The proportion of aggravation for pain and ROM did not significantly differ between the two groups. The charts below compare the outcomes at 2-6 months (FU1) and one year (FU2).

The authors concluded that the effectiveness of conservative treatment was not inferior to arthroscopic repair for patients >50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. 

Comment: This was a retrospective study: patients were not randomized to the two groups. The treatment protocols were not standardized. However, the results are of importance in indicating that patients with these tears can improve with non-operative measures.