Operative versus conservative treatment of small, nontraumatic supraspinatus tears in patients older than 55 years: over 5-year follow-up of a randomized controlled trial

Abstract

<div><h3>Background</h3><p>Nontraumatic <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/rotator-cuff" title="Learn more about rotator cuff from ScienceDirect's AI-generated Topic Pages">rotator cuff</a> tear is a common shoulder problem that can be treated either conservatively or operatively. In the previous publications of the 1- and 2-year results of this trial, we found no significant between-group clinical differences. The aim of this study was to investigate the differences in mid-term clinical and radiologic outcomes in patients older than 55 years.</p></div><div><h3>Materials and methods</h3><p>One hundred eighty shoulders with symptomatic, nontraumatic supraspinatus tears were randomly assigned to 1 of the 3 cumulatively designed treatment groups: physiotherapy (group 1); <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/acromioplasty" title="Learn more about acromioplasty from ScienceDirect's AI-generated Topic Pages">acromioplasty</a> and physiotherapy (group 2); and rotator cuff repair, acromioplasty, and physiotherapy (group 3). The change in the Constant score was the primary outcome measure. The secondary outcome measures were the change in the <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/visual-analog-scale" title="Learn more about visual analog scale from ScienceDirect's AI-generated Topic Pages">visual analog scale</a> score for pain and patient satisfaction. Radiologic analysis included evaluation of glenohumeral <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/osteoarthritis" title="Learn more about osteoarthritis from ScienceDirect's AI-generated Topic Pages">osteoarthritis</a> (OA) and <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/rotator-cuff-rupture" title="Learn more about rotator cuff tear from ScienceDirect's AI-generated Topic Pages">rotator cuff tear</a> arthropathy (CTA).<br></p><div><div><div><h3>Results</h3><p>A total of 150 shoulders (mean age, 71 years) were available for analysis after a mean follow-up period of 6.2 years. The mean sagittal tear size of the supraspinatus tendon tear at baseline was 10 mm in all groups (<em>P</em> = .33). During follow-up, 8 shoulders in group 1 and 2 shoulders in group 2 crossed over to rotator cuff repair. The mean baseline Constant score was 57.1, 58.2, and 58.7 in groups 1, 2, and 3, respectively (<em>P</em> = .85). There were no significant differences (<em>P</em> = .84) in the mean change in the Constant score: 18.5 in group 1, 17.9 in group 2, and 20.0 in group 3. There were no statistically significant differences in the change in the visual analog scale pain score (<em>P</em> = .74) and patient satisfaction (<em>P</em> = .83). At follow-up, there were no statistically significant differences in the mean progression of glenohumeral OA (<em>P</em> = .538) or CTA (<em>P</em> = .485) among the groups. However, the mean progression of glenohumeral OA from baseline to follow-up was statistically significant in the trial population (<em>P</em> = .0045).</p></div><div><h3>Conclusions</h3><p>On the basis of this study, operative treatment is no better than conservative treatment regarding small, nontraumatic, single-tendon supraspinatus tears in patients older than 55 years. Operative treatment does not protect against degeneration of the glenohumeral joint or CTA. Conservative treatment is a reasonable option for the primary initial treatment of these tears.</p></div></div></div><div><div><h2>Level of evidence</h2><div>Level II</div><div>Randomized Controlled Trial</div><div>Treatment Study</div></div><div><h2>Keywords</h2><div>Rotator cuff tear</div><div>conservative treatment</div><div>rotator cuff repair</div><div>Constant score</div><div>VAS pain score</div><div>patient satisfaction</div><div>radiographic analysis</div><div>randomized controlled trial</div></div></div> </div>