This systematic review with meta-analysis pooled 6 RCTs comparing rotator cuff repair against conservative treatment in 435 patients. It asked whether surgery produces better pain and function than physiotherapy for any type of rotator cuff tear. Outcomes were tracked at 6, 12, and 24 months using the Constant Score and pain scales.
When you counsel a patient with a degenerative rotator cuff tear, this paper is the honest answer: repair edges out physiotherapy on pain and function scores, but the gap is too small for the patient to feel. Across 6, 12, and 24 months, repair won statistically yet never reached the minimal clinically important difference (10.4 points on Constant Score, 2.17 on pain).
That means both paths reliably improve the patient, so start most degenerative tears with a real course of physiotherapy. The counterargument lives in the natural history: unrepaired tears enlarged >5 mm in 29.2% of patients, and a tear that grows can become harder to fix later.
Treat the whole patient, not just the MRI. Age, tear characteristics, activity demands, expectations, and psychosocial factors should drive the decision more than tear size alone. Remember the scope limit: these data come from small or supraspinatus-only tears, so do not extend this equivalence to massive or traumatic tears.
This systematic review with meta-analysis pooled 6 RCTs comparing rotator cuff repair against conservative treatment in 435 patients. It asked whether surgery produces better pain and function than physiotherapy for any type of rotator cuff tear. Outcomes were tracked at 6, 12, and 24 months using the Constant Score and pain scales.
When you counsel a patient with a degenerative rotator cuff tear, this paper is the honest answer: repair edges out physiotherapy on pain and function scores, but the gap is too small for the patient to feel. Across 6, 12, and 24 months, repair won statistically yet never reached the minimal clinically important difference (10.4 points on Constant Score, 2.17 on pain).
That means both paths reliably improve the patient, so start most degenerative tears with a real course of physiotherapy. The counterargument lives in the natural history: unrepaired tears enlarged >5 mm in 29.2% of patients, and a tear that grows can become harder to fix later.
Treat the whole patient, not just the MRI. Age, tear characteristics, activity demands, expectations, and psychosocial factors should drive the decision more than tear size alone. Remember the scope limit: these data come from small or supraspinatus-only tears, so do not extend this equivalence to massive or traumatic tears.