When Should We Repair Partial-Thickness Rotator Cuff Tears? Outcome Comparison Between Immediate Surgical Repair Versus Delayed Repair After 6-Month Period of Nonsurgical Treatment.Am J Sports Med. 2018 04; 46(5):1091-1096.AJ
Patients with partial-thickness rotator cuff tears (PTRCTs) can be treated nonoperatively and/or undergo operative treatment, but the ideal time for surgical intervention is unclear.
To compare the results of immediate arthroscopic rotator cuff repair with repair after 6 months of nonoperative care of PTRCTs involving more than 50% of the tendon thickness.
Randomized controlled trial; Level of evidence, 2.
The authors prospectively randomized and analyzed 78 consecutive patients diagnosed with either isolated bursal-side or articular-side PTRCTs (supraspinatus only). Group 1 (n = 44) received immediate rotator cuff repair. Group 2 (n = 34) received delayed rotator cuff repair after 6 months of nonoperative treatment. The American Shoulder and Elbow Surgeons (ASES) Score, Constant score, visual analog scale (VAS) for pain, and range of motion at initial visit; months 3, 6, and 12 postoperatively; and the last visit after 24 months were used for the evaluation. Cuff integrity was assessed with magnetic resonance imaging at 12 months postoperatively.
There were no significant differences in age, sex (18/26 vs 13/21, male/female), symptom duration, composition of PTRCTs, or clinical outcomes between groups 1 and 2 (P > .05). In group 2, 10 patients voluntarily dropped out from the study due to improvement of symptoms during the 6 months of preoperative nonoperative treatment. The mean follow-up period in groups 1 and 2 was 31.9 ± 1.5 months and 37.0 ± 2.2 months, respectively. At the end of the study, both groups showed significant improvements in terms of functional scores and pain VAS scores compared with the initial period. There were no significant differences between the 2 groups, except for lower pain VAS score and higher ASES Score in group 2 at 6 months postoperatively. At 12 months postoperatively, 1 patient from group 1 and 2 patients from group 2 experienced a retear.
Both immediate surgical repair and delayed repair after nonsurgical care for PTRCTs were effective in improving clinical outcomes, and there was a very low incidence of retears in both groups. However, at 6 months postoperatively, superior functional outcomes were observed in the delayed repair group compared with the immediate repair group. A trial period of preoperative nonsurgical care is reasonable, and immediate surgical repair is not crucial for the treatment of PTRCT.