Arthroscopic Repair Versus Conservative Treatment in Degenerative Cuff Tears: Midterm Results

Abstract

(1) Background and aim: The benefit of surgical treatment compared to conservative management is unclear in degenerative cuff tears, and there is limited evidence regarding midterm functional outcomes. This study sought to compare the midterm functional outcomes of surgical versus conservative treatment for rotator cuff tears. (2) Methods: All patients on the waiting list for arthroscopy of cuff tears in a single center between 2013 and 2015 were analyzed. They were divided into two groups: those who underwent surgery (arthroscopy group) and those who declined the procedure (orthopedic group). The primary endpoint was shoulder functionality, evaluated with the CMS, SST, and SPADI-SP questionnaires. Inverse probability of treatment weighting (IPTW) was used to account for differences between the groups. (3) Results: Of 57 patients (67 (62-71) years old, 47% women), 32 were in the arthroscopy group and 25 in the orthopedic group. Functionality was assessed at a median of 7 (7-8) years after diagnosis. The patients in the arthroscopy group were younger (p = 0.023) and more frequently women (p = 0.074). No significant differences were observed in the type of tear (p = 0.205) or laterality (p = 0.164). Functional outcome analysis showed more favorable scores in the surgical group: constant (74.5 ± 16.6 vs. 58.4 ± 23, p = 0.016), SST (7.3 ± 3.1 vs. 4.9 ± 4.2, p = 0.016), and SPADI-SP (35.7 ± 26.6 vs. 56.1 ± 30.4, p = 0.006). (4) Conclusions: In this cohort of patients with cuff tears, arthroscopic repair was associated with better clinical and functional midterm results compared to conservative treatment, although the benefit was less evident in older patients and those with complete tears.

Keywords: arthroscopy; degenerative cuff tear; rehabilitation.

Figure 1

Flow diagram of the patients included in this study.

Figure 2

Covariate balance. Dotted lines represent ±0.1 standardized mean differences. After the weighting, a good balance was observed, with standardized mean differences between −0.1 and 0.1 for all the covariates included in the propensity score model.

Figure 3

Midterm results according to treatment group: graphic representation. CMS: Constant–Murley Score; SST: Simple Shoulder Test; SPADI: Shoulder Pain and Disability Index; VAS: visual analogue scale. p values were obtained from IPTW—linear regression models.

Figure 4

Constant–Murley Score range of motion according to treatment group. A: arthroscopy group. O: orthopedic group. T12: 12th thoracic vertebrae; SI: sacroiliac. p values were obtained from IPTW–linear regression models.

Figure 5

Subgroup analysis forest plot: (A) CMS: Constant–Murley Score; (B) SST: Simple Shoulder Test; (C) SPADI: Shoulder Pain and Disability Index; and (D) VAS: visual analogue scale.