This multicenter Finnish RCT compared three treatments for isolated non-traumatic supraspinatus tears in patients over 55. The three arms were physiotherapy alone, acromioplasty plus physiotherapy, and cuff repair plus acromioplasty plus physiotherapy. The primary outcome was the Constant score at one year.
When an older patient presents with an atraumatic, symptomatic, isolated supraspinatus tear under 75% of the insertion, this trial supports starting with structured physiotherapy rather than rushing to repair. At one year, adding acromioplasty or a formal repair produced no Constant score benefit over physiotherapy alone, and satisfaction exceeded 87% in every arm.
The practical safety net is the low crossover rate: fewer than 1 in 13 conservatively treated patients elected surgery within a year, so a trial of therapy rarely burns a bridge. Weigh two caveats. Follow-up was only one year, and the study excluded massive tears, multi-tendon tears, and true traumatic tears, so these conclusions do not extend to acute or large tears in younger patients.
The cost signal is also relevant: physiotherapy cost roughly half of repair, driven largely by indirect societal costs. This paper fits the broader literature supporting non-operative management for degenerative cuff disease.
This multicenter Finnish RCT compared three treatments for isolated non-traumatic supraspinatus tears in patients over 55. The three arms were physiotherapy alone, acromioplasty plus physiotherapy, and cuff repair plus acromioplasty plus physiotherapy. The primary outcome was the Constant score at one year.
When an older patient presents with an atraumatic, symptomatic, isolated supraspinatus tear under 75% of the insertion, this trial supports starting with structured physiotherapy rather than rushing to repair. At one year, adding acromioplasty or a formal repair produced no Constant score benefit over physiotherapy alone, and satisfaction exceeded 87% in every arm.
The practical safety net is the low crossover rate: fewer than 1 in 13 conservatively treated patients elected surgery within a year, so a trial of therapy rarely burns a bridge. Weigh two caveats. Follow-up was only one year, and the study excluded massive tears, multi-tendon tears, and true traumatic tears, so these conclusions do not extend to acute or large tears in younger patients.
The cost signal is also relevant: physiotherapy cost roughly half of repair, driven largely by indirect societal costs. This paper fits the broader literature supporting non-operative management for degenerative cuff disease.