Clinical Outcomes of Conservative Treatment and Arthroscopic Repair of Rotator Cuff Tears: A Retrospective Observational Study
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Objective To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear.Methods In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments.Results A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p<0.001) and the ROM in forward flexion (p<0.001) were significantly improved in both groups. The ROM in internal rotation did not significantly change after conservative treatment and arthroscopic repair. The pain assessment score and ROM were not significantly different between the two groups. Retear was observed in 9.6% of patients who had an arthroscopic repair and tear progression was found in 6.7% of those who underwent conservative treatment. The proportion of aggravation for pain and ROM did not significantly differ between the two groups.Conclusion The effectiveness of conservative treatment is not inferior to arthroscopic repair for patients >50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear.
Abstract
Objective To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear.Methods In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments.Results A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p<0.001) and the ROM in forward flexion (p<0.001) were significantly improved in both groups. The ROM in internal rotation did not significantly change after conservative treatment and arthroscopic repair. The pain assessment score and ROM were not significantly different between the two groups. Retear was observed in 9.6% of patients who had an arthroscopic repair and tear progression was found in 6.7% of those who underwent conservative treatment. The proportion of aggravation for pain and ROM did not significantly differ between the two groups.Conclusion The effectiveness of conservative treatment is not inferior to arthroscopic repair for patients >50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear.
참고문헌 (21)
- Tempelhof S, "Age-related prevalence of rotator cuff tears in asymptomatic shoulders", J Shoulder Elbow Surg, 8, pp.296~299 (1999)
- Tashjian RZ, "Epidemiology, natural history, and indications for treatment of rotator cuff tears", Clin Sports Med, 31, pp.589~604 (2012)
- Pedowitz RA, "Optimizing the management of rotator cuff problems", J Am Acad Orthop Surg, 19, pp.368~379 (2011)
- Safran O, "Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger", Am J Sports Med, 39, pp.710~714 (2011)
- Maman E, "Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging", J Bone Joint Surg Am, 91, pp.1898~1906 (2009)
- Kamath G, "Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears", J Bone Joint Surg Am, 91, pp.1055~1062 (2009)
- Yamaguchi K, "Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically", J Shoulder Elbow Surg, 10, pp.199~203 (2001)
- Kijima H, "Long-term follow-up of cases of rotator cuff tear treated conservatively", J Shoulder Elbow Surg, 21, pp.491~494 (2012)
- Dunn WR, "Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393patients with a symptomatic atraumatic full-thickness rotator cuff tear", J Bone Joint Surg Am, 96, pp.793~800 (2014)
- Lindley K, "Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature", Am J Orthop (Belle Mead NJ), 39, pp.592~600 (2010)
- Yamaguchi K, "Transitioning to arthroscopic rotator cuff repair:the pros and cons", Instr Course Lect, 52, pp.81~92 (2003)
- Nho SJ, "Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair", J Bone Joint Surg Am, 89(3), pp.127~136 (2007)
- Kukkonen J, "Treatment of non-traumatic rotator cuff tears: a randomised controlled trial with one-year clinical results", Bone Joint J, 96B, pp.75~81 (2014)
- Moosmayer S, "Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year followup", J Bone Joint Surg Am, 96, pp.1504~1514 (2014)
- Cofield RH, "Subscapular muscle transposition for repair of chronic rotator cuff tears", Surg Gynecol Obstet, 154, pp.667~672 (1982)
- Goutallier D, "Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan", Clin Orthop Relat Res, (304), pp.78~83 (1994)
- Heers G, "Efficacy of home exercises for symptomatic rotator cuff tears in correlation to the size of the defect", Sportverletz Sportschaden, 19, pp.22~27 (2005)
- Koubaa S, "Conservative management of full-thickness rotator cuff tears: a prospective study of 24 patients", Ann Readapt Med Phys, 49, pp.62~67 (2006)
- Bokor DJ, "Results of nonoperative management of fullthickness tears of the rotator cuff", Clin Orthop Relat Res, (294), pp.103~110 (1993)
- Itoi E, "Conservative treatment of rotator cuff tears", Clin Orthop Relat Res, (275), pp.165~173 (1992)
- Kuhn JE, "Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study", J Shoulder Elbow Surg, 22, pp.1371~1379 (2013)