Evidence-Based Answers

Nontraumatic supraspinatus tears: PT = PT + surgery at 1 year

Clinical Question:
In adults with nontraumatic supraspinatus tears, is physical therapy alone as effective as physical therapy plus surgery after 1 year?

Bottom Line:
In this study, the long-term outcomes of adults with nontraumatic supraspinatus tears who are treated conservatively are similar to those of patients treated with two different surgical approaches. (LOE = 2b)

Reference:
Kukkonen J, Joukainen A, Lehtinen J, et al. Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. Bone Joint J 2014;96(1):75-81.  [PMID:24395315]

Study Design:
Randomized controlled trial (nonblinded)

Funding:
Unknown/not stated

Allocation:
Concealed

Setting:
Outpatient (specialty)

Synopsis:
This group of surgeons randomly assigned 180 adults older than 55 years with isolated nontraumatic supraspinatus tears to 1 of 3 treatment groups: physical therapy (PT); PT plus acromioplasty; or PT plus acromioplasty plus rotator cuff repair. Although they used intention-to-treat analysis to evaluate the main outcome, the authors don't report if any study personnel (other than the radiologists) were aware of the treatment allocation. The research staff determined the multidimensional Constant score for each patient at baseline and then 3, 6, and 12 months after intervention. The authors report that a difference of 10 points on the Constant score is the minimal clinically important difference. Thirteen patients didn't complete the study. At 3 months, the group receiving triple therapy had lower Constant scores than the other groups, but by 6 months the scores were comparable. At the end of the study, 87% of patients treated with PT were satisfied compared with 95% and 96% in the other treatment groups. The study was designed to have enough power to detect modest differences in the Constant score. This is one of many studies showing long-term outcomes of various orthopedic interventions are comparable (eg, steroid injections for shoulder pain vs conservative treatment).