Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Nov;47(13):3065-3072.
doi: 10.1177/0363546519873840. Epub 2019 Sep 13.

Comparative Effectiveness of Operative Versus Nonoperative Treatment for Rotator Cuff Tears: A Propensity Score Analysis From the ROW Cohort

Nitin B Jain  1   2 , Gregory D Ayers  3 , Run Fan  3 , John E Kuhn  2 , Jon J P Warner  4 , Keith M Baumgarten  5 , Elizabeth Matzkin  6 , Laurence D Higgins  7
Affiliations
Comparative Study

Comparative Effectiveness of Operative Versus Nonoperative Treatment for Rotator Cuff Tears: A Propensity Score Analysis From the ROW Cohort

Nitin B Jain et al. Am J Sports Med. 2019 Nov.

Abstract

Background: The evidence to support operative versus nonoperative treatment for rotator cuff tears is sparse and inconclusive.

Purpose: To assess pain and functional outcomes in patients undergoing operative and nonoperative treatments for rotator cuff tears.

Study design: Cohort study; Level of evidence, 3.

Methods: From March 2011 to February 2015, a multicenter cohort of patients with rotator cuff tears undergoing operative and nonoperative treatments was recruited. Patients completed a detailed history questionnaire, the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons (ASES) standardized form and underwent magnetic resonance imaging. In addition to baseline assessments, patients received follow-up questionnaires at 3, 6, 12, and 18 months. Propensity score weighting was used to balance differences in characteristics of the operative and nonoperative groups.

Results: Adjusted for propensity scores, the operative (n = 50) and nonoperative (n = 77) groups had similar characteristics, as evidenced by the small standardized mean differences between the groups. Adjusted mean differences in the SPADI and ASES scores between the operative and nonoperative groups were -22.0 points (95% CI, -32.1 to -11.8) and -22.2 points (95% CI, -32.8 to -11.6) at 18 months, respectively. The operative group had a significantly higher proportion of patients who showed ≥30% (P = .002) and ≥50% (P < .0001) improvement in SPADI and ASES scores as compared with the nonoperative group.

Conclusion: In this prospective cohort study, patients undergoing operative treatment had significantly better pain and functional outcomes as compared with patients undergoing nonoperative treatment for rotator cuff tears. Differences between the 2 groups in SPADI and ASES scores at the 6- to 18-month time points met the minimal clinically important difference (depending on the threshold used). A large randomized controlled trial is needed to answer this question more definitively.

Keywords: arthroscopic surgery; nonoperative; rotator cuff tears.

PubMed Disclaimer

Figures

Figure 1a:
Figure 1a:
Observed SPADI Scores with 95% Confidence Intervals of Operative and Non-Operative Treatments over 18 Months of Follow-Up
Figure 1b:
Figure 1b:
Observed ASES Scores with 95% Confidence Intervals of Operative and Non-Operative Treatments over 18 Months of Follow-Up
Figure 2a:
Figure 2a:
Predicted mean differences with 95% confidence intervals in SPADI Scores between Operative and Non-Operative Treatments over 18 Months of Follow-Up
Figure 2b:
Figure 2b:
Predicted mean differences with 95% confidence intervals in ASES Scores between Operative and Non-Operative Treatments over 18 Months of Follow-Up
See this image and copyright information in PMC

References

    1. Agency for Healthcare Research and Quality (AHRQ). Comparative effectiveness of non-operative and operative treatments for rotator cuff tears. Effective Health Care: AHRQ; 2008. - PubMed
    1. Ainsworth R, Lewis JS. Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review. Br J Sports Med. 2007;41(4):200–210. - PMC - PubMed
    1. Austin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivariate Behav Res. 2011;46(3):399–424. - PMC - PubMed
    1. Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994(308):90–97. - PubMed
    1. Baysal D, Balyk R, Otto D, Luciak-Corea C, Beaupre L. Functional outcome and health-related quality of life after surgical repair of full-thickness rotator cuff tear using a mini-open technique. Am J Sports Med. 2005;33(9):1346–1355. - PubMed

Publication types