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Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: a prospective randomized trial
Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Kalmar Cty Hosp, Sweden.ORCID iD: 0000-0003-3766-8410
Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
2020 (English)In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 29, no 3, p. 459-470Article in journal (Refereed) Published
Abstract [en]

Background: Previous randomized trials on cuff repair have included mainly degenerative tears, but studies on acute traumatic tears are lacking. We aimed to compare early surgical repair with nonoperative treatment for traumatic supraspinatus tears. Methods: We did a 2-center randomized controlled trial of patients with small rotator cuff tears mainly involving supraspinatus, comparing surgical repair (n = 32) and physiotherapy (n = 26). The primary outcome was a group difference in the Constant-Murley score at 12-month follow-up. Secondary outcomes were differences in the Western Ontario Rotator Cuff index, pain (Numerical Rating Scale 0-10), and Euro quality-of-life-visual analog scale. We used magnetic resonance imaging to assess retear rate, tear progression, fatty infiltration, and atrophy. Results: The mean age was 59.7 years (range, 44-77 years), median sagittal tear size was 9.7 mm (range, 421 mm), and baseline characteristics were well balanced between the 2 groups. The repair group had a median Constant-Murley of 83 (25 quartile range [QR)) and the physiotherapy group 78 (QR, 22) at 12 months, with the between-group difference in medians of 4.5 (-5 to 9, 95% confidence interval; P = .68). The corresponding values for the Western Ontario Rotator Cuff index were 91% (QR, 24) vs. 86% (QR, 24), with the between-group difference of 5.0 (-4 to 9, 95% confidence interval; P- .62). There was no difference in Numerical Rating Scale or in Euro quality-of-life-visual analog scale. Retear was found in 63% of repaired patients and tear progression amp;gt;5 mm in 29.2% of unrepaired patients. Conclusions: We found no significant differences in clinical outcomes between cuff repair and nonoperative treatment at 12-month follow-up. Approximately one third of unrepaired patients had a tear enlargement of more than 5 mm. (C) 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER , 2020. Vol. 29, no 3, p. 459-470
Keywords [en]
Rotator cuff; rotator cuff repair; conservative treatment; randomized controlled trial; tear progression; magnetic resonance imaging
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-164657DOI: 10.1016/j.jse.2019.10.013ISI: 000514557100014PubMedID: 31924516OAI: oai:DiVA.org:liu-164657DiVA, id: diva2:1417575
Available from: 2020-03-29 Created: 2020-03-29 Last updated: 2020-03-29

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Ranebo, MatsBjörnsson Hallgren, HannaHolmgren, TheresaAdolfsson, Lars
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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health SciencesDepartment of Orthopaedics in LinköpingDivision of Prevention, Rehabilitation and Community Medicine
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Journal of shoulder and elbow surgery
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