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

• Lee WH
• Do HK
• Lee JH
• Kim BR
• Noh JH
• Choi SH
• Chung SG
• Lee SU
• Choi JE
• Kim S
• Kim MJ
• Lim JY

• KMID: 2309924
• DOI: http://doi.org/10.5535/arm.2016.40.2.252

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.

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  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.

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