Surgical reconstruction of small and medium rotator cuff tears shows superior long-term results

Abstract

Abstract Background Degenerative rotator cuff tears are common in elderly patients. However, the treatment strategies remain controversial. While physiotherapy can lead to pain relief and improved shoulder function, spontaneous tendon healing will not take place and, thus, non-operative management bears the risk of tear progression. Surgical management is the only way to restore the tendon-to-bone interface in spite of a considerable number of retears. Methods The present study reviewed the data provided by randomized controlled trials (RCTs) that have compared physiotherapy with surgical rotator cuff repair. Systematic reviews of this kind have been published before; however, this paper re-analyzes the data, given that Moosmayer et al. recently published an RCT with 10-year follow-up. Such long-term data are comparatively rare in the field of musculoskeletal surgery and therefore a reconsideration of treatment recommendations seems necessary. Results The results show a mean difference in the Constant and Murley score of 6.2 points (95% confidence interval, 2.6; 9.7, P < 0.001) in favor of the surgical groups. The visual analog scale pain score also improved more in the operatively treated patients with a mean difference of −1.4 (95% confidence interval −2.1; −0.8, P < 0.001). Conclusion In summary, this review shows superior clinical results for surgical repair of small- to medium-sized degenerative rotator cuff tears especially in the long term compared to physiotherapy.