title: Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial.
abstract: BACKGROUND
  Good clinical results have been reported for both surgical and conservative treatment of rotator cuff tears. The primary aim of this randomized controlled trial was to compare functional and radiologic improvement after surgical and conservative treatment of degenerative rotator cuff tears.
  
  
  METHODS
  We conducted a randomized controlled trial that included 56 patients with a degenerative full-thickness rotator cuff tear between January 2009 and December 2012; 31 patients were treated conservatively, and rotator cuff repair was performed in 25 patients. Outcome measures, including the Constant-Murley score (CMS), visual analog scale (VAS) pain and VAS disability scores, were assessed preoperatively and after 6 weeks and 3, 6, and 12 months. Magnetic resonance imaging was performed preoperatively and at 12 months postoperatively.
  
  
  RESULTS
  At 12 months postoperatively, the mean CMS was 81.9 (standard deviation [SD], 15.6) in the surgery group vs 73.7 (SD, 18.4) in the conservative group (P = .08). VAS pain (P = .04) and VAS disability (P = .02) were significantly lower in the surgery group at the 12-month follow-up. A subgroup analysis showed postoperative CMS results were significantly better in surgically treated patients without a retear compared with conservatively treated patients (88.5 [SD, 6.2] vs 73.7 [SD, 18.4]).
  
  
  CONCLUSIONS
  In our population of patients with degenerative rotator cuff tears who were randomly treated by surgery or conservative protocol, we did not observe differences in functional outcome as measured with the CMS 1 year after treatment. However, significant differences in pain and disabilities were observed in favor of surgical treatment. The best outcomes in function and pain were seen in patients with an intact rotator cuff postoperatively.
authors.affiliation: Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: lambersheerspink@gmail.com.
authors.forename: Frederik O
authors.initials: FO
authors.lastname: Lambers Heerspink
authors.affiliation: Department of Orthopedic Surgery, Martini Hospital Groningen, Groningen, The Netherlands.
authors.forename: Jos J A M
authors.initials: JJ
authors.lastname: van Raay
authors.affiliation: Department of Orthopedic Surgery, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Rinco C T
authors.initials: RC
authors.lastname: Koorevaar
authors.affiliation: Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Pepijn J M
authors.initials: PJ
authors.lastname: van Eerden
authors.affiliation: Department of Radiology, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Robin E
authors.initials: RE
authors.lastname: Westerbeek
authors.affiliation: Department of Orthopedic Surgery, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: van 't Riet
authors.affiliation: Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: van den Akker-Scheek
authors.affiliation: Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Diercks
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012422:Rupture, Spontaneous; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013708:Tendon Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: MRI; Rotator cuff; conservative treatment; cuff integrity; randomized controlled trial; rotator cuff repair