title: Medium- to long-term results of a randomized controlled trial to assess the efficacy of arthoscopic-subacromial decompression versus mini-open repair for the treatment of medium-sized rotator cuff tears.
abstract: BACKGROUND
  We report on the medium- to long-term results of a randomized controlled trial (RCT) aiming to determine whether rotator cuff repair confers any advantage over arthroscopic sub-acromial decompression (ASAD) alone in the management of medium-sized rotator cuff tears.
  
  
  METHODS
  Ethical approval was sought to follow-up patients previously enrolled in a completed and previously published RCT comparing the outcome of ASAD with mini-open cuff repair for the treatment of rotator cuff tear. Forty-two patients were enrolled in the original study, with a mean of 64 years (range 54 years to 77 years).
  
  
  RESULTS
  Fifteen of the original 17 patients randomized to ASAD alone and 18 of the original 25 patients randomized to cuff repair were available for follow-up. Each patient underwent American Shoulder and Elbow Surgeons (ASES), Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scoring, and clinical and ultrasound examination. Mean duration of follow-up was 7 years (range 5 years to 11 years). There was no statistically significant difference in terms of ASES, DASH and Constant scores at follow-up between the two groups. Some 33% of patients in the cuff-repair group had a proven re-rupture on ultrasound. This patient subgroup had significantly worse Constant scores compared to patients where the repair remained intact. None of the patients from either group developed cuff-tear arthropathy requiring arthroplasty surgery.
  
  
  CONCLUSIONS
  In this medium- to longer-term study, there is no demonstrable significant benefit of cuff repair over decompression alone for the treatment of medium-sized rotator cuff tears, in terms of ASES, DASH and Constant scores for pain, function and strength modules. The presence of cuff tear does not necessitate surgical repair. This conclusion should drive surgical strategies and shared decision-making between patients and surgeons.
authors: Sherwood Forest Hospitals NHS Trust, King's Mill Hospital, Mansfield Road, Sutton in Ashfield, UK.
authors: Amit Sharad Chandra
authors: AS
authors: Bidwai
authors: Wrightington Upper Limb Unit, Wigan, UK.
authors: Ann
authors: A
authors: Birch
authors: Wrightington Hospital, Appley Bridge, Wigan, UK.
authors: David
authors: D
authors: Temperley
authors: Mersey Deanery, UK.
authors: Saurabh
authors: S
authors: Odak
authors: Wrightington Upper Limb Unit, Wigan, UK.
authors: Michael J
authors: MJ
authors: Walton
authors: Wrightington Upper Limb Unit, Wigan, UK.
authors: John F
authors: JF
authors: Haines
authors: Wrightington Upper Limb Unit, Wigan, UK.
authors: Ian
authors: I
authors: Trail
keywords: cuff repair; cuff tear; shoulder arthroscopy