Perspective

Tendon repair of rotator cuff tears superior to physiotherapy

Stefan Moosmayer

At 10-year follow-up, primary tendon repair results were superior to physiotherapy in the treatment of small- and medium-sized rotator cuff tears, according to study results.

“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, told Orthopedics Today. “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.”

Moosmayer and his colleagues collected data from 103 patients with rotator cuff tears no bigger than 3 cm. Researchers randomly assigned patients to receive either primary tendon repair or physiotherapy with optional secondary repair. The Constant score was used as the primary outcome measure. Secondary outcomes were the self-reported section of the American Shoulder and Elbow Surgeons (ASES) score, the SF-36 Health Survey, measurement of pain, strength and pain-free mobility of the patient’s shoulder and patient satisfaction. Postoperative follow-up occurred at 6 months and at 1, 2, 5 and 10 years.

Ninety-one of 103 patients attended the last follow-up. After 10 years, the tendon repair group experienced better Constant and ASES scores, less pain, better patient satisfaction and greater shoulder range of motion and strength.

Fourteen patients opted for secondary surgery after physiotherapy and scored 10 points less on the Constant score compared with the primary repair group.

Forty-one percent of the tears that remained unrepaired over 10 years showed a tear enlargement that exceeded 10 mm and had a poor outcome.

“We found that although both groups showed improvements in the first 2 years, by year 10 shoulder function remained stable in the surgical group, but had declined in the physiotherapy group. Our study confirms earlier reports that unrepaired tears widen over time and deteriorate functionally and we suspect that, over the 10-year study period, anatomic tear deterioration in the physiotherapy group may have led to worse outcomes,” Moosmayer said.

Moosmayer and his colleagues concluded that the results of this long-term study support a primary tendon repair for younger patients who want to return to an active lifestyle. – by Casey Tingle and Julia Lowndes

Reference:

Moosmayer S, et al. J Bone Joint Surg Am. 2019;doi:10.2106/JBJS.18.01373.

For more information:

Stefan Moosmayer, MD, PhD, can be reached at Department of Orthopaedic Surgery, Martina Hansens Hospital, Dønskiveien 8, 1346 Gjettum, Norway; email: st.moos@online.no.

Disclosure: Moosmayer reports he received a grant from the South-Eastern Norway Regional Health Authority.

Stefan Moosmayer

At 10-year follow-up, primary tendon repair results were superior to physiotherapy in the treatment of small- and medium-sized rotator cuff tears, according to study results.

“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, told Orthopedics Today. “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.”

Moosmayer and his colleagues collected data from 103 patients with rotator cuff tears no bigger than 3 cm. Researchers randomly assigned patients to receive either primary tendon repair or physiotherapy with optional secondary repair. The Constant score was used as the primary outcome measure. Secondary outcomes were the self-reported section of the American Shoulder and Elbow Surgeons (ASES) score, the SF-36 Health Survey, measurement of pain, strength and pain-free mobility of the patient’s shoulder and patient satisfaction. Postoperative follow-up occurred at 6 months and at 1, 2, 5 and 10 years.

Ninety-one of 103 patients attended the last follow-up. After 10 years, the tendon repair group experienced better Constant and ASES scores, less pain, better patient satisfaction and greater shoulder range of motion and strength.

Fourteen patients opted for secondary surgery after physiotherapy and scored 10 points less on the Constant score compared with the primary repair group.

Forty-one percent of the tears that remained unrepaired over 10 years showed a tear enlargement that exceeded 10 mm and had a poor outcome.

“We found that although both groups showed improvements in the first 2 years, by year 10 shoulder function remained stable in the surgical group, but had declined in the physiotherapy group. Our study confirms earlier reports that unrepaired tears widen over time and deteriorate functionally and we suspect that, over the 10-year study period, anatomic tear deterioration in the physiotherapy group may have led to worse outcomes,” Moosmayer said.

Moosmayer and his colleagues concluded that the results of this long-term study support a primary tendon repair for younger patients who want to return to an active lifestyle. – by Casey Tingle and Julia Lowndes

Reference:

Moosmayer S, et al. J Bone Joint Surg Am. 2019;doi:10.2106/JBJS.18.01373.

For more information:

Stefan Moosmayer, MD, PhD, can be reached at Department of Orthopaedic Surgery, Martina Hansens Hospital, Dønskiveien 8, 1346 Gjettum, Norway; email: st.moos@online.no.

Disclosure: Moosmayer reports he received a grant from the South-Eastern Norway Regional Health Authority.

    Perspective
    Lucca Lacheta

    Lucca Lacheta

    This prospective, randomized clinical study has compared rotator cuff repair to physiotherapy for acute-on-chronic and chronic small- to medium-sized rotator cuff tears at 10-year long-term follow-up, showing superior results in patients who were treated primarily with tendon repair. This solves some of the remaining questions about the efficacy of rotator cuff reconstruction when critically compared to conservative management. In previous studies, authors were able to show statistically significant improvements in functional outcome; however, this 10-year follow-up study demonstrated this difference has become even more evident and clinically relevant over time. Concerns with tendon repairs in small- to medium-sized cuff tears include failure rates of up to 36%. The current study reported re-tears in 34% of patients; however, in contrast to unrepaired tears, re-tears have been shown to be functionally stable over time. In terms of timing of rotator cuff repair, another interesting finding in this study is that delayed repair resulted in worse outcomes compared to primary surgically treated patients. In summary, this clinical trial supports a primary surgical approach for this type of rotator cuff tear in an active patient population.

    References:

    Goutallier D, et al. J Shoulder Elbow Surg. 2003;doi:10.1016/S1058-2746(03)00211-8.

    Kluger R, et al. Am J Sports Med. 2011;doi:10.1177/0363546511406395.

    Levy O, et al. J Bone Joint Surg Br. 2008;doi:10.1302/0301-620X.90B10.19989.

    Moosmayer S, et al. J Bone Joint Surg Am. 2014;doi:10.2106/JBJS.M.01393.

    Moosmayer S, et al. J Bone Joint Surg Br. 2010;doi:10.1302/0301-620X.92B1.22609.

     

    • Lucca Lacheta, MD
    • Steadman Philippon Research Institute
      Vail, Colorado

    Disclosures: Lacheta reports no relevant financial disclosures.