Ann Rehabil Med.  2016 Apr;40(2):252-262. 10.5535/arm.2016.40.2.252.

Clinical Outcomes of Conservative Treatment and Arthroscopic Repair of Rotator Cuff Tears: A Retrospective Observational Study

Affiliations
  • 1National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea. drlim1@snu.ac.kr
  • 2Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 3Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.
  • 4Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.

Abstract


OBJECTIVE
To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear.
METHODS
In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments.
RESULTS
A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p<0.001) and the ROM in forward flexion (p<0.001) were significantly improved in both groups. The ROM in internal rotation did not significantly change after conservative treatment and arthroscopic repair. The pain assessment score and ROM were not significantly different between the two groups. Retear was observed in 9.6% of patients who had an arthroscopic repair and tear progression was found in 6.7% of those who underwent conservative treatment. The proportion of aggravation for pain and ROM did not significantly differ between the two groups.
CONCLUSION
The effectiveness of conservative treatment is not inferior to arthroscopic repair for patients >50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear.

Keyword

Arthroscopy; Conservative treatment; Rotator cuff; Tendon injuries; Treatment outcome

MeSH Terms

Arthrography
Arthroscopy
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Observational Study*
Outcome Assessment (Health Care)
Pain Measurement
Range of Motion, Articular
Retrospective Studies*
Rotator Cuff*
Shoulder
Tears*
Tendon Injuries
Tendons
Treatment Outcome
Ultrasonography

Figure

  • Fig. 1 The flow chart of the patient data source, sampling and analysis.

  • Fig. 2 Typical cases of right supraspinatus tendon tears (arrow) in coronal and sagittal planes of fatsaturated T2-weighted MR images: high-grade partial-thickness (A and B), small- (C and D) and medium-sized full-thickness tears (E and F).

  • Fig. 3 (A) Pain assessment score, (B) forward flexion ROM, (C) internal rotation ROM in arthroscopic repair and conservative treatment groups at the baseline, 2–6 months (FU1) and 1 year (FU2). In the scale of internal rotation, the numerical values represent each vertebral level (i.e., 7–12 represent T12-T7 vertebral level, respectively). These values were adjusted for sex, age, tear on dominant side, symptom onset, trauma history and tear classification. ROM, range of motion; FU, follow-up.


Cited by  1 articles

A Follow-Up Study of Rotator Cuff Tear Using Magnetic Resonance Imaging
Jun-Sung Won, Woo-Seung Lee, Jae-Hong Park, Seung-Nam Ko, In-Wook Seo
J Korean Orthop Assoc. 2018;53(1):38-43.    doi: 10.4055/jkoa.2018.53.1.38.


Reference

1. Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999; 8:296–299. PMID: 10471998.
Article
2. Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012; 31:589–604. PMID: 23040548.
3. Pedowitz RA, Yamaguchi K, Ahmad CS, Burks RT, Flatow EL, Green A, et al. Optimizing the management of rotator cuff problems. J Am Acad Orthop Surg. 2011; 19:368–379. PMID: 21628648.
Article
4. Safran O, Schroeder J, Bloom R, Weil Y, Milgrom C. Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger. Am J Sports Med. 2011; 39:710–714. PMID: 21310940.
Article
5. Maman E, Harris C, White L, Tomlinson G, Shashank M, Boynton E. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Joint Surg Am. 2009; 91:1898–1906. PMID: 19651947.
Article
6. Kamath G, Galatz LM, Keener JD, Teefey S, Middleton W, Yamaguchi K. Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears. J Bone Joint Surg Am. 2009; 91:1055–1062. PMID: 19411453.
Article
7. Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001; 10:199–203. PMID: 11408898.
Article
8. Kijima H, Minagawa H, Nishi T, Kikuchi K, Shimada Y. Long-term follow-up of cases of rotator cuff tear treated conservatively. J Shoulder Elbow Surg. 2012; 21:491–494. PMID: 22265764.
Article
9. Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY, et al. Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear. J Bone Joint Surg Am. 2014; 96:793–800. PMID: 24875019.
10. Lindley K, Jones GL. Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature. Am J Orthop (Belle Mead NJ). 2010; 39:592–600. PMID: 21720577.
11. Yamaguchi K, Levine WN, Marra G, Galatz LM, Klepps S, Flatow EL. Transitioning to arthroscopic rotator cuff repair: the pros and cons. Instr Course Lect. 2003; 52:81–92. PMID: 12690842.
12. Nho SJ, Shindle MK, Sherman SL, Freedman KB, Lyman S, MacGillivray JD. Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair. J Bone Joint Surg Am. 2007; 89(Suppl 3):127–136. PMID: 17908878.
Article
13. Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EK, Kauko T, et al. Treatment of non-traumatic rotator cuff tears: a randomised controlled trial with one-year clinical results. Bone Joint J. 2014; 96B:75–81. PMID: 24395315.
14. Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, et al. Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up. J Bone Joint Surg Am. 2014; 96:1504–1514. PMID: 25232074.
15. Cofield RH. Subscapular muscle transposition for repair of chronic rotator cuff tears. Surg Gynecol Obstet. 1982; 154:667–672. PMID: 7071702.
16. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994; (304):78–83. PMID: 8020238.
17. Heers G, Anders S, Werther M, Lerch K, Hedtmann A, Grifka J. Efficacy of home exercises for symptomatic rotator cuff tears in correlation to the size of the defect. Sportverletz Sportschaden. 2005; 19:22–27. PMID: 15776325.
18. Koubaa S, Ben Salah FZ, Lebib S, Miri I, Ghorbel S, Dziri C. Conservative management of full-thickness rotator cuff tears: a prospective study of 24 patients. Ann Readapt Med Phys. 2006; 49:62–67. PMID: 16387384.
19. Bokor DJ, Hawkins RJ, Huckell GH, Angelo RL, Schickendantz MS. Results of nonoperative management of full-thickness tears of the rotator cuff. Clin Orthop Relat Res. 1993; (294):103–110. PMID: 8358901.
Article
20. Itoi E, Tabata S. Conservative treatment of rotator cuff tears. Clin Orthop Relat Res. 1992; (275):165–173. PMID: 1735208.
Article
21. Kuhn JE, Dunn WR, Sanders R, An Q, Baumgarten KM, Bishop JY, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013; 22:1371–1379. PMID: 23540577.
Article
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