Summary

Multiple techniques have been reported for the treatment of rotator cuff tears. For degenerative rotator cuff tears (lesions without complete tears), conservative treatment and arthroscopic repair are commonly used options. With an increasing focus on health care efficiency, analyzing the cost-effectiveness and clinical outcomes of treatment modalities has become increasingly important.

Abstract

Objective

The purpose of this study was to analyze the costs and clinic outcomes of sodium hyaluronate treatment(SH) and arthroscopic repair(AR) of degenerative rotator cuff tears.

Method

We conducted a randomized controlled trial that included 59 patients with a degenerative rotator cuff tear between February 2014 and January 2015. All the patients were >= 50 years old. 30 patients were treated with SH, and AR was performed in 29 patients. Outcome measures, including range of motion (ROM) ,the interval improvement （II）of the Constant-Murley score (CMS)、visual analog scale (VAS) pain 、VAS disability scores (VASDS) ，University of California at Los Angeles score（UCLA），and cost of treatment(CTM) , were assessed preoperatively and after 6 weeks and 3, 6, and 12 months. Cost-effectiveness was CTM/II. Magnetic resonance imaging was performed preoperatively and at 12 months postoperatively.
Result: After 12 months postoperatively, no patient was lost. The ROM in forward flexion (p<0.001) were significantly improved in both groups. The ROM in internal rotation did not significantly change after sodium hyaluronate treatment and arthroscopic repair. The ROM were not significantly different between the two groups. The mean II of CMS (IICMS) was 26.1 (standard deviation [SD], 4.6) in AR vs 18(SD, 16.1) in SH (P =0.08). The mean II of UCLA (IIUCLA) was 16.3(SD, 3.1) in AR vs 13.1(SD, 2.6) in SH (P=0.043).The II of VAS (IIVAS) pain (4.6 (SD,1.6)in AR ,3.6(SD,2.3) in SH ,P =0 .072) and the II of VASDS (IIVASDS) (4.1(SD,0.9) in AR,3.5(1.1) in SH,P =0 .03) were significantly lower in the surgery group at the 12-month follow-up. For cost-effectiveness SH was superior to AR in IICMS、IIUCLA、IIVAS and IIVASDS（P<0.001）.

Conclusion

The effectiveness of SH is not obvious inferior to arthroscopic repair in IICMS,UCLA , IIVAS , IIVASDS and ROM for patients >50 years old with Degenerative Rotator Cuff Tears in a 1-year follow-up period. But for cost-effective treatment SH was much better than AR.