Managing Full-Thickness Rotator Cuff Tears
Editor’s Note: Research papers intended for presentation at the canceled annual meeting of the American Academy of Orthopaedic Surgeons are now available online at the AAOS Virtual Education Experience. We’ll be highlighting a few of the more interesting papers throughout the summer.
Non-operative treatment is considered an acceptable approach for managing full-thickness rotator cuff tears.
But all things being equal, surgery might be the better choice: In a recent propensity matched analysis, patients who opted for surgery experienced superior outcomes compared with patients who decided to try non-operative management first.
In the study from the University of Michigan, 107 patients per group were matched according to age, sex, symptom duration, Functional Comorbidity Index, tear size, injury mechanism, and atrophy. All patients were over age 18 and had a full-thickness rotator cuff tear on MRI. Patient-report outcomes – the Normalized Western Ontario Rotator Cuff Index, the American Shoulder and Elbow Surgeons score, the Single Assessment Numerical Evaluation, and pain score on a visual analog scale – were collected at baseline and at 6, 12, and at least 24 months.
The researchers noted that although patients in both groups showed improvements in pain and function, those in the surgery group had significantly greater improvement in patient-reported outcomes at final follow-up (P<0.001). Better outcomes were independently associated with younger age, shorter symptom duration, and rotator cuff repair, according to longitudinal regression analysis.
Ramme A, Robbins CB, Patel K, Carpenter JE, Bedi A, Gagnier JJ, Miller BS. Surgical versus Nonsurgical Management of Rotator Cuff Tears: A Propensity Matched Analysis. Paper 539. AAOS Virtual Education Experience.
Ramme A, Robbins CB, Patel K, Carpenter JE, Bedi A, Gagnier JJ, Miller BS. Surgical versus nonsurgical management of rotator cuff tears: a matched-pair analysis. J Bone Joint Surg. 2019 Oct 2;101(19):1775-1782. doi: 10.2106/JBJS.18.01473.