This multicenter prospective cohort study by the MOON Shoulder Group evaluated a standardized physical therapy protocol for atraumatic full-thickness rotator cuff tears. It enrolled 452 patients across nine US sites and followed them for up to two years. The primary question: how often does structured PT allow patients to avoid surgery, and how much do patient-reported outcomes improve?
When a middle-aged patient walks in with an atraumatic full-thickness rotator cuff tear and shoulder pain, the reflex is often to counsel surgery. This study gives you data to counsel otherwise first.
With a structured program averaging just one supervised PT visit per week, 75% of patients avoided surgery at two years and achieved clinically significant improvements in ASES, WORC, and SANE scores.
The 12-week window is the critical decision point. Kaplan-Meier analysis shows that patients who get through 12 weeks without electing surgery almost never choose it later. This means a focused 12-week trial of PT is both a treatment and a triage tool — it identifies the minority who genuinely need surgery while successfully managing the majority.
The finding that tear severity does not correlate with pain severity is board-high-yield: it means you cannot use MRI tear size to predict who will respond to PT or who needs surgery. The authors argue that weakness or functional loss, not pain, may be the more appropriate surgical indication.
For boards and clinical practice, the key threshold to remember is 12 weeks: if the patient hasn't improved enough to avoid surgery by then, they likely won't improve further with continued PT.
This multicenter prospective cohort study by the MOON Shoulder Group evaluated a standardized physical therapy protocol for atraumatic full-thickness rotator cuff tears. It enrolled 452 patients across nine US sites and followed them for up to two years. The primary question: how often does structured PT allow patients to avoid surgery, and how much do patient-reported outcomes improve?
When a middle-aged patient walks in with an atraumatic full-thickness rotator cuff tear and shoulder pain, the reflex is often to counsel surgery. This study gives you data to counsel otherwise first.
With a structured program averaging just one supervised PT visit per week, 75% of patients avoided surgery at two years and achieved clinically significant improvements in ASES, WORC, and SANE scores.
The 12-week window is the critical decision point. Kaplan-Meier analysis shows that patients who get through 12 weeks without electing surgery almost never choose it later. This means a focused 12-week trial of PT is both a treatment and a triage tool — it identifies the minority who genuinely need surgery while successfully managing the majority.
The finding that tear severity does not correlate with pain severity is board-high-yield: it means you cannot use MRI tear size to predict who will respond to PT or who needs surgery. The authors argue that weakness or functional loss, not pain, may be the more appropriate surgical indication.
For boards and clinical practice, the key threshold to remember is 12 weeks: if the patient hasn't improved enough to avoid surgery by then, they likely won't improve further with continued PT.