This Level II randomized controlled trial compared three treatments for small, nontraumatic supraspinatus tears in patients over 55. The arms were physiotherapy alone, acromioplasty plus physiotherapy, and cuff repair plus acromioplasty plus physiotherapy. The question: does surgical repair produce better mid-term clinical and radiographic outcomes than conservative care?
When an older patient presents with a small, atraumatic, single-tendon supraspinatus tear, this trial supports starting with structured physiotherapy rather than rushing to repair.
At mid-term follow-up, all three arms landed within a couple of Constant points of each other, and any surgical edge stayed below the 10-point MCID. That is the number to remember when weighing evidence in this population.
A key teaching point: repair did not stop glenohumeral OA or cuff tear arthropathy from progressing. Degeneration behaved like a joint-wide process, tracked here by the Samilson-Prieto and Hamada classifications, independent of whether the tendon was fixed. The low crossover rate (16% for physiotherapy) tells you conservative care rarely fails catastrophically in these patients.
The evidence is not universal. Moosmayer's trials showed a growing surgical advantage out to 10 years, and traumatic or larger multi-tendon tears were excluded here, so this conclusion should not be generalized to younger patients or acute tears.
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This Level II randomized controlled trial compared three treatments for small, nontraumatic supraspinatus tears in patients over 55. The arms were physiotherapy alone, acromioplasty plus physiotherapy, and cuff repair plus acromioplasty plus physiotherapy. The question: does surgical repair produce better mid-term clinical and radiographic outcomes than conservative care?
When an older patient presents with a small, atraumatic, single-tendon supraspinatus tear, this trial supports starting with structured physiotherapy rather than rushing to repair.
At mid-term follow-up, all three arms landed within a couple of Constant points of each other, and any surgical edge stayed below the 10-point MCID. That is the number to remember when weighing evidence in this population.
A key teaching point: repair did not stop glenohumeral OA or cuff tear arthropathy from progressing. Degeneration behaved like a joint-wide process, tracked here by the Samilson-Prieto and Hamada classifications, independent of whether the tendon was fixed. The low crossover rate (16% for physiotherapy) tells you conservative care rarely fails catastrophically in these patients.
The evidence is not universal. Moosmayer's trials showed a growing surgical advantage out to 10 years, and traumatic or larger multi-tendon tears were excluded here, so this conclusion should not be generalized to younger patients or acute tears.