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Response to: ‘Correspondence on ‘Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation’’ by Randelli et al
  1. Sanna Cederqvist1,
  2. Tapio Flinkkilä2,
  3. Jari Ylinen3,
  4. Hannu Kautiainen4,5,
  5. Antti Tuominen6,
  6. Ilkka Kiviranta7,8,
  7. Juha Paloneva9,10
  8. the Surgery for rotator cuff disease Finland (SURFIN) Investigators
    1. 1 Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
    2. 2 Department of Orthopedics and Traumatology, Oulu University Hospital, Oulu, Finland
    3. 3 Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyvaskyla, Central Finland, Finland
    4. 4 Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
    5. 5 Research Center, Folkhälsan, Helsinki, Finland
    6. 6 Department of Surgery, Central Finland Hospital Nova, Jyvaskyla, Finland
    7. 7 Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
    8. 8 Department of Orthopedics and Traumatology, University of Helsinki, Helsinki, Finland
    9. 9 Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
    10. 10 Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
    1. Correspondence to Dr Sanna Cederqvist, Orthopaedics and Traumatology, Tampere University Hospital, 33520 Tampere, Finland; sanna.cederqvist{at}

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    We warmly thank Randelli and coworkers for their interest in our work.1 Our randomised, pragmatic, controlled trial compared surgical and non-surgical treatments for rotator cuff disease (RCD) with or without full-thickness tendon tears after unsuccessful initial rehabilitation.2

    Randelli and coworkers commented that the power of our study lies in the fact that potential eligible patients underwent a systematic, adequately performed 3-month rehabilitation, after which only patients who remained symptomatic were randomised; we agree. Symptoms alleviated in 102 of the 417 shoulders with chronic RCD (mean duration of symptoms 9 months before recruitment) during the 3 month, pragmatic nonoperative treatment. This indicates that conservative management should be carried out in all patients with chronic RCD before considering surgical treatment for full-thickness rotator cuff tear.

    Randelli and coworkers criticised us for not reporting baseline characteristics of the prespecified subgroups (RCD with and without full-thickness tendon rupture). They also noted that while …

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    • Handling editor Josef S Smolen

    • Collaborators The Surgery for rotator cuff disease Finland (SURFIN) Investigators: Markus Sormaala; Tero Irmola; Heidi Lehtokangas; Juho Liukkonen; Konsta Pamilo; Tero Ridanpää; Kai Sirniö; Juhana Leppilahti.

    • Contributors Concept and design: JP, IK, HK, JY. Acquisition analysis or data interpretation: SC, TF, JY, HK, AT, IK, JP. SC and JP had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.Drafting the manuscript: SC, TF, JY, HK, AT, IK, JP. Critical revision of the manuscript for important intellectual content: SC, TF, JY, HK, AT, IK, JP. Statistical analysis: HK, SC, JP. Funding procurement: JP, IK, JL. Supervision: JP, IK, HK.

    • Funding This work was supported by grants from the Academy of Finland (grant 12321/13 September 2007) 265646/17 April 2013) and National Competitive Research Funding of the University of Eastern Finland. None of the writers has any conflicts of interest relevant to this article.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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