CONSERVATIVE VERSUS SURGICAL TREATMENT FOR ROTATOR CUFF TEARS: A PROSPECTIVE RANDOMIZED CONTROL TRIAL

The appropriate treatment for rotator cuff tear (RCT) is debated. Both tendon repair and physical therapy have been shown to be successful in treating small to medium size rotator cuff tears. However, there are limited high-level studies that compare conservative treatment with physiotherapy. This randomized controlled trial aims to compare surgical and conservative treatment of RCT, in terms of functional outcomes, rotator cuff (RC) integrity, and muscle atrophy or fatty degeneration. From January 2020 to December 2022, 88 patients with atraumatic, symptomatic, isolated full-thickness supraspinatus tendon tears documented with MRI were recruited at Campus Bio Medio Hospital. Written informed consent was obtained from each patient. The study was registered on “ISRCTNregistry” (ISRCTN12733667). Patients were randomly assigned to surgical repair (Group 1) or conservative treatment (Group 2) and were evaluated by clinical scores and MRI at randomization and after 6 months from the treatment. The surgical treatment group (Group 1) included 45 patients (45 shoulders). There were 21 (47%) male and 24 (53%) female patients, with a mean age of 58,8 ± 7, 25 years (range 44-74 years). The right shoulder was involved in 39 (87%) patients and the left shoulder in 6 (13%) patients. Twenty-four patients were evaluated at 6 months (T1). The conservative treatment group (Group 2) included 44 patients (44 shoulders). There were 19 (43%) male and 25 (57%) female patients, with a mean age of 60,2 ± 6,9 years (range 46-74 years). The right shoulder was involved in 28 (64%) patients and the left shoulder in 16 (36%) patients. Seventeen patients were evaluated at 6 months (T1). Significant improvements in clinical outcomes (Constant score, ASES Shoulder Score, VAS and Oxford Shoulder Score) were found 6 months after surgery. Moreover, no significant implementation in clinical outcomes for patients treated with physiotherapy and no significant differences between T0 and T1 in terms of fatty degeneration and muscle atrophy in both groups were observed. Patients treated with surgery had no significant differences in clinical outcomes compared with patients treated with physiotherapy. Additional research and follow– up are needed to establish a recommendation for conservative or surgical treatment for individual patients.