TY - JOUR
T1 - Comparing surgical repair with conservative treatment for degenerative rotator cuff tears
T2 - a randomized controlled trial
AU - Lambers Heerspink, Okke
AU - van Raay, Jos J. A. M.
AU - Koorevaar, Rinco C. T.
AU - van Eerden, Pepijn J. M.
AU - Westerbeek, Robin E.
AU - van 't Riet, Esther
AU - van den Akker-Scheek, Inge
AU - Diercks, Ronald L.
N1 - Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
PY - 2015/8
Y1 - 2015/8
N2 - Background: Good clinical results have been reported for both surgical and conservative treatment of rotator cuff tears. The primary aim of this randomized controlled trial was to compare functional and radiologic improvement after surgical and conservative treatment of degenerative rotator cuff tears.Methods: We conducted a randomized controlled trial that included 56 patients with a degenerative full-thickness rotator cuff tear between January 2009 and December 2012; 31 patients were treated conservatively, and rotator cuff repair was performed 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.Results: At 12 months postoperatively, the mean CMS was 81.9 (standard deviation [SD], 15.6) in the surgery group vs 73.7 (SD, 18.4) in the conservative group (P = .08). VAS pain (P = .04) and VAS disability (P = .02) were significantly lower in the surgery group at the 12-month follow-up. A subgroup analysis showed postoperative CMS results were significantly better in surgically treated patients without a retear compared with conservatively treated patients (88.5 [SD, 6.2] vs 73.7 [SD, 18.4]).Conclusion: In our population of patients with degenerative rotator cuff tears who were randomly treated by surgery or conservative protocol, we did not observe differences in functional outcome as measured with the CMS 1 year after treatment. However, significant differences in pain and disabilities were observed in favor of surgical treatment. The best outcomes in function and pain were seen in patients with an intact rotator cuff postoperatively. (C) 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.
AB - Background: Good clinical results have been reported for both surgical and conservative treatment of rotator cuff tears. The primary aim of this randomized controlled trial was to compare functional and radiologic improvement after surgical and conservative treatment of degenerative rotator cuff tears.Methods: We conducted a randomized controlled trial that included 56 patients with a degenerative full-thickness rotator cuff tear between January 2009 and December 2012; 31 patients were treated conservatively, and rotator cuff repair was performed 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.Results: At 12 months postoperatively, the mean CMS was 81.9 (standard deviation [SD], 15.6) in the surgery group vs 73.7 (SD, 18.4) in the conservative group (P = .08). VAS pain (P = .04) and VAS disability (P = .02) were significantly lower in the surgery group at the 12-month follow-up. A subgroup analysis showed postoperative CMS results were significantly better in surgically treated patients without a retear compared with conservatively treated patients (88.5 [SD, 6.2] vs 73.7 [SD, 18.4]).Conclusion: In our population of patients with degenerative rotator cuff tears who were randomly treated by surgery or conservative protocol, we did not observe differences in functional outcome as measured with the CMS 1 year after treatment. However, significant differences in pain and disabilities were observed in favor of surgical treatment. The best outcomes in function and pain were seen in patients with an intact rotator cuff postoperatively. (C) 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.
KW - Rotator cuff
KW - conservative treatment
KW - rotator cuff repair
KW - cuff integrity
KW - randomized controlled trial
KW - MRI
KW - FULL-THICKNESS TEARS
KW - MEDIUM-SIZED TEARS
KW - ARTHROSCOPIC REPAIR
KW - FOLLOW-UP
KW - INTEGRITY
KW - TENDON
KW - PHYSIOTHERAPY
KW - MANAGEMENT
KW - SHOULDER
KW - EFFICACY
U2 - 10.1016/j.jse.2015.05.040
DO - 10.1016/j.jse.2015.05.040
M3 - Article
C2 - 26189808
SN - 1058-2746
VL - 24
SP - 1274
EP - 1281
JO - Journal of Shoulder and Elbow Surgery
JF - Journal of Shoulder and Elbow Surgery
IS - 8
ER -