Both surgical repair as conservative management may serve as treatment options for patients with full-thickness rotator cuff tears. It is important to know if conservative treatment has also a successful result in the long-term.
Boorman et al. (2018, JSES) examined 5-year outcomes of patients with chronic full-thickness rotator cuff tears previously enrolled in a nonoperative, home based rotator cuff tear treatment program. After 3 months of rehabilitation, the outcome in these patients was defined as “successful” or “failed.” Patients in the successful group were essentially asymptomatic and did not require surgery. Patients in the failed group were symptomatic and consented to undergo surgical repair. All patients were followed up at 1 year, 2 years, and 5 or more years. At 5 or more years, approximately 75% of patients (93 patients in total) remained successfully treated with nonoperative treatment at 5 years and reported a mean rotator cuff quality-of-life index score of 83 of 100! Furthermore, between 2 and 5 years, only 3 patients who had previously been defined as having a successful outcome became more symptomatic and underwent surgical rotator cuff repair. Those in whom nonoperative treatment had failed and who underwent surgical repair had a mean rotator cuff quality-of-life index score of 89 at 5-year follow-up. The operative and nonoperative groups at 5-year follow-up were not significantly different.
At 5 or more years, approximately 75% of patients (93 patients in total) remained successfully treated with nonoperative treatment at 5 years and reported a mean rotator cuff quality-of-life index score of 83 of 100!
Implications for practice
The results of this study show that the success of a nonoperative treatment of 3 months can have a long-lasting successful result in many patients with a chronic, full-thickness rotator cuff tear. Patients who ended up requiring surgical repair (after trying the conservative treatment, but failed) had similar outcomes to those who underwent surgery early in the study, as well as those in whom nonoperative treatment was successful. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, this study shows that patients can do very well over time. Important to note is that only self-reported outcomes were included in the study, and that this does not indicate whether a tear is increased in size or not. The authors of this study recommend following up non–surgically treated patients regularly (annually) to ensure that those in whom deterioration occurs are identified and operated on if necessary.
While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, this study shows that patients can do very well over time.
Reference: Boorman R, More K, Hollinshead R, Wiley J, Mohtadi N, Lo I, Brett K. What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2018 Mar;27(3):444-448. doi: 10.1016/j.jse.2017.10.009.
Written by: Birgit Castelein