Moosmayer cuff surgery vs physiotherapy

Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff: A randomised controlled study of 103 patients with one-year follow-up.

Moosmayer S, Lund G, Seljom U, et al. The Journal of bone and joint surgery. British volume 2010 · PMID 20044684 · doi:10.1302/0301-620x.92b1.22609

Question

Is primary tendon repair better than physiotherapy for small and medium-sized rotator cuff tears?

Design

Single-centre RCT in Norway with blinded outcome assessment and one-year follow-up.

Patients

Adults with symptomatic small or medium-sized rotator cuff tears.

Intervention

Primary rotator cuff repair

Comparison

Physiotherapy, with secondary repair offered if it gave insufficient benefit

Primary outcome

Constant score at 12 months

Key result

Primary repair gave significantly better Constant and ASES scores, pain-free abduction and pain relief at one year. Roughly a fifth of the physiotherapy group went on to secondary repair because of insufficient improvement.

Limitations

Single centre with a modest sample and only one-year follow-up in this report; patients and therapists were not blinded and crossover complicates the comparison.

Impact on practice

Supports offering repair to suitable patients with symptomatic small to medium tears, while recognising that many do acceptably with physiotherapy and can have delayed repair if it fails.