Primary tendon repair superior to physiotherapy in long-term treatment of small-to-medium rotator cuff tears
According to a study with a 10-year follow-up, tendon repair yielded superior results compared with physiotherapy in the treatment of small- and medium-sized rotator cuff tears.
“This study presents for the first time long-term results from a comparison between tendon repair and physiotherapy in the treatment of rotator cuff tears,” Stefan Moosmayer, MD, PhD, and colleagues told Healio.com/Orthopedics. “It shows that results are more stable after tendon repair and that between-group differences increase over time. This supports the use of a primary tendon repair for small- and medium-sized rotator cuff tears in younger and active patients.”
Moosymayer and colleagues collected data from 103 patients with rotator cuff tears not exceeding 3 cm. Patients received random assignment to primary tendon repair or physiotherapy with an optional secondary repair. Researchers conducted follow-ups after 6 months and at 1, 2, 5 and 10 years. Data included measurement of shoulder pain, motion and strength; patient satisfaction; Constant score; and the self-report section of the American Shoulder and Elbow Surgeons score (ASES).
Treatment efficacy was higher for primary tendon repair at all follow-ups. At long-term follow-ups, shoulder function remained stable in the surgical group but declined in the physiotherapy group. After 10 years, primary tendon repair displayed preferable outcomes on the Constant score (P = .002), the ASES (P = .001), a 10-cm visual analog scale for pain (P < .001), pain-free abduction (P = .007) and pain-free flexion (P = .01).
The 10-year follow-up rate for all patients was 97%. Fourteen patients opted for secondary surgery after physiotherapy. These patients scored 10 points lower on the Constant score than the primary repair group (P = .03).
“It is known that unrepaired tears can widen over time and we suspect that over the 10-year study period, anatomic tear deterioration in the physiotherapy group may have led to worse outcomes,” researchers said. – by Julia Lowndes
Disclosures: Moosmayer reports he received a grant from the South-Eastern Norway Regional Health Authority.