These patients were initially managed with a comprehensive, nonoperative, home-based treatment program.
After 3 months, the outcome in these patients was defined as “successful” if they were essentially asymptomatic and as "failed" if they were symptomatic and consented to undergo surgical repair.
At 5 or more years, all patients were contacted for follow-up; the response rate was 84%.
Approximately 75% of patients remained successfully treated with nonoperative treatment at 5 years and reported a mean rotator cuff quality-of-life index score of 83 of 100.
Approximately 75% of patients remained successfully treated with nonoperative treatment at 5 years and reported a mean rotator cuff quality-of-life index score of 83 of 100.
Those in whom nonoperative treatment had failed and who underwent surgical repair had a mean rotator cuff quality-of-life index score of 89 at 5-year follow-up.
The operative and nonoperative groups were not significantly different at 5-year follow-up (P = .11).
The authors concluded that nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear.
Comment: It is recognized that most patients with chronic rotator cuff tears are minimally symptomatic. A small subset of all patients with chronic rotator cuff tears present to surgeons because of symptoms of pain, weakness or crepitus.
This study suggests a cost-effective approach to these patients: start with a 3 month non operative program and reserve surgery for those who do not improve.
The results of this study are consistent with those of
Those authors 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.
See also: Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis
See also: Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis
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