Published last year in the Annals of the Royal College of Surgeons and now available to the public, is an in-depth analysis of research conducted in the field of rotator cuff repair titled. ‘Degenerative rotator cuff tear, repair or not repair? A review of current evidence’. The goal was to address whether a surgical or non-surgical approach would be better for patients. Among the study’s authors were three members of the London Shoulder Specialists; Mr Ali Narvani, Mr Steven Corbett and Mr Andrew Wallace.
Here, we’ll review the evidence that was revealed and what it means for those suffering from a rotator cuff tear.
Clinical outcomes for non-surgical repairs
In our analysis of research relating to clinical outcomes for non-surgical repairs, we found results were dependent upon the severity of the tear. The review focused on a multicentre study which included 452 patients who had atraumatic rotator cuff tears. They were treated with physiotherapy and reviewed at 6 and 12 weeks. Significant improvements were identified at both the 6- and 12-week review, although after two years, 26% of patients chose to undergo surgery.
It appears non-surgical treatment provides great early results, but patients still often go on to need surgery. Those with large and severe rotator cuff tears experienced the fewest benefits of non-operative treatment. In fact, for older patients with massive tears, the problem simply became worse over time. This is particularly true for patients with tears that affected three or more tendons.
Clinical outcomes for surgical repairs
A lot of studies have been carried out to determine the effectiveness of surgical rotator cuff repair. In one study which involved data from 1600 patients, it showed after six months there was a significant improvement in most patients in overhead motion and pain.
Another looked at surgical repair of full thickness tears. A total of 263 shoulders were included in the study. After five years, 94% of patients didn’t require any further surgery. Most impressively, after 10 years 83% of patients still didn’t require additional surgery.
So, surgical repair does appear to be more effective in the long term. However, it did take six months for patients to experience full improvements. This is slightly longer than the initial outcome for non-surgical treatment.
The role of age in rotator cuff repair results
There were conflicting results in the studies regarding whether age played a role in results. It is widely believed that age does impact the outcome of rotator cuff repair. However, some studies showed that there were no differences between the results experienced in younger age groups and those in older groups.
The only exception here is tendon healing. Evidence suggests that older patients do appear to take longer to heal when tendons are damaged. However, for most rotator cuff repairs, surgery had the same success rate in older patients as it did in younger ones.
The findings of the review confirm that rotator cuff repair surgery does tend to be the best option for patients. However, it does depend upon the size and severity of the tear. For patients experiencing a mild tear, physiotherapy and a non-surgical approach can be effective. However, for more severe and larger tears, surgery is the most effective option.
During the current COVID-19 crisis, all non-urgent / elective surgery bookings and appointments are postponed. These are now restarting though there are some restrictions in a quickly-changing landscape, but the London Shoulder Specialists are still available for consultation if you require more advice on rotator cuff repair. Consultations can be carried out either by telephone or video link and can be arranged by emailing firstname.lastname@example.org or by calling 020 3195 2442.