RT Journal Article
SR Electronic
T1 Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 796
OP 802
DO 10.1136/annrheumdis-2020-219099
VO 80
IS 6
A1 Sanna Cederqvist
A1 Tapio Flinkkilä
A1 Markus Sormaala
A1 Jari Ylinen
A1 Hannu Kautiainen
A1 Tero Irmola
A1 Heidi Lehtokangas
A1 Juho Liukkonen
A1 Konsta Pamilo
A1 Tero Ridanpää
A1 Kai Sirniö
A1 Juhana Leppilahti
A1 Ilkka Kiviranta
A1 Juha Paloneva
YR 2021
UL http://ard.bmj.com/content/80/6/796.abstract
AB Background Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear.Methods In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up.Results At the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI −3 to 10, p=0.25) for pain and 3.4 (95% CI −0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery.Conclusions Non-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment.Trial registration details ClinicalTrials.gov, NCT00695981 and NCT00637013.Data sharing not applicable as no data sets generated and/or analysed for this study. Study data cannot be shared publicly because of confidentiality requirements under Finnish law. De-identified patient data is available from the study group and from Central Finland Hospital (contact via www.ksshp.fi, juha.paloneva@ksshp.fi) for researchers who meet the criteria for access to confidential data.