2015 ISAKOS Biennial Congress ePoster #2437

A Prospective Cohort Study of Patients Treated Surgically or Non-Surgically for Full-Thickness Rotator Cuff Tears

Bruce S. Miller, MD, MS, Ann Arbor, MI UNITED STATES
Christopher Robbins, PhD, Ann Arbor, MI UNITED STATES
James Carpenter, Ann Arbor, MI UNITED STATES
Asheesh Bedi, MD, Ann Arbor, MI UNITED STATES
Joel Gagnier, ND, MSc, PhD, Ann Arbor, MI UNITED STATES
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA

FDA Status Not Applicable

Summary: Patients with rotator cuff tears who undergo surgical or nonsurgical treatment tend to improve, with surgical patients improving more rapidly and to a greater degree for all measured outcomes.

Abstract:

OBJECTIVES:
The objectives of this project are: (1) to compare the effectiveness of surgical versus non-surgical management of full-thickness rotator cuff tears, (2) to detect variables that predict treatment allocation, and (3) to detect variables that predict success within each treatment group.

Methods

Adult patients presenting with symptomatic full thickness rotator cuff tears were recruited for inclusion in this IRB-approved prospective pragmatic cohort study. Subjects completed baseline written questionnaires which included a Functional Comorbidity Index, a Charlson Comorbidity Index, a demographics form, WORC score, ASES score, VR-12, modified shoulder activity level, patient satisfaction forms, and a visual analogue pain scale. Patients then proceeded with planned treatment, either surgical or non-surgical, after agreement with the treating surgeon. Written questionnaires were mailed to participants at the following intervals after baseline: 4 weeks, 8 weeks, 16 weeks, 32 weeks, 48 weeks, and 64 weeks. We described all patient demographic characteristics, and performed logistic regression for variables associated with treatment allocation and longitudinal modeling with generalized estimating equations for treatment effects across the follow-up period. We also used Student’s t-tests and Wilcoxon rank-sum tests where appropriate, to explore differences in treatment effects between the groups for all outcome measures at each time point.

Results

A total of 212 consecutive patients were included, with 119 (56%) allocated to surgery and 93 (44%) to non-surgical management. Data collection compliance was 100% at baseline, and 83% at 64 weeks.


Predictors for allocation to surgery were lower age (M=60.4, SD=9.6; p<.001 OR 0.91), lower BMI (M=30.3, SD=6.2; p<.10 OR 0.93), and those who reported a known traumatic injury (67%; p<.05 OR 0.38) and worse baseline WORC scores (M=1252, SD=377; p<.05 OR 1.00) than subjects in the non-surgical cohort.


At baseline, the surgery group reported significantly higher pain scores and less favorable ASES and WORC scores than the non-surgical group. Both treatment groups improved significantly on all outcome measures across the follow up period with surgical subjects improving at a faster rate and to a greater degree. Subjects in the surgical group reported more favorable mean change in all outcomes measured relative to the non-surgical group (ASES p<.001) (WORC p<.001) (PAIN VAS p<.001).


Several variables predicted improvements across time in the surgical group, including: shoulder activity level (p<.01), shorter duration of symptoms (p<.01), and non-diabetic (p<.001). For the non-surgical group, the following variables predicted improved outcomes across time: functional comorbity (p<.05), shorter duration of symptoms (p<.01), and non-workers compensation case (p<.05). These predictors varied by outcome measure.

Conclusions

Patients with rotator cuff tears who undergo surgical or nonsurgical treatment tend to improve, with surgical patients improving more rapidly and to a greater degree for all measured outcomes. The treatment groups differed on important variables at baseline, and there appear to be significant predictors of improved outcomes. These findings may help guide treatment allocation in patients with symptomatic rotator cuff tears.