These authors compared early surgical repair (n=32) with nonoperative treatment (n=26) for traumatic supraspinatus tears using a 2-center randomized controlled trial.
The mean age was 59.7 years; median sagittal tear size was one centimeter.
All patients had a complete 12-month follow-up, except 3 patients who did all the clinical scores but refused followup MRI
They found no significant differences in clinical outcomes between the cuff repair and nonoperative groups. The repair group had a Constant-Murley median of 83 , mean 77±15, and the physiotherapy group median 78, mean 76±15 at 12 months, with the between-group difference in medians of 4.5 (5 to 9, 95% confidence interval; P . .68). The corresponding values for the Western Ontario Rotator Cuff index were 91% (QR, 24) vs. 86% (QR, 24), with the between-group difference of 5.0 (4 to 9, 95% confidence interval; P ..62). There was no difference in Numerical Rating Scale or in Euro quality-of-life-visual analog scale.
Retears were found in 6.5% of repaired patients and tear progression >5 mm in 29.2% of unrepaired patients. There were two infections in patients having repair (one was a crossover from the PT group).
Comment: This a virtually unique randomized study comparing PT and surgery for acute suprapspinatus tears. While the clinical outcomes were not significantly different, the tear progression in the unrepaired tendons is of concern and must be balanced against the retear rate and complications in the surgical group.
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