This Level II RCT compared arthroscopic-era miniopen rotator cuff repair with a structured conservative protocol for degenerative, nontraumatic full-thickness cuff tears. 56 patients were randomized and followed for 1 year with clinical scores and MRI. The question: does surgery beat conservative care for functional recovery?
When counseling a patient with a degenerative, atraumatic full-thickness cuff tear, this trial supports offering a structured conservative program first. At 1 year, functional scores were statistically indistinguishable, and even the significant pain and disability gains from surgery were small.
The key teaching point is that outcome tracks with repair integrity, not with the decision to operate. Patients whose repair stayed intact did best, but retear patients did no better than those never operated on. With a 73.7% retear rate here, that caveat carries weight, and side-to-side repairs (1 of 6 healed) reinforce preferring tendon-to-bone fixation.
This fits the broader evidence: two prior RCTs (Kukkonen, Moosmayer) also found differences below the clinically important threshold. The unsolved problem is prediction. Baseline age, CMS, retraction, and atrophy did not distinguish who would heal, so we cannot yet reliably select surgical candidates.
This Level II RCT compared arthroscopic-era miniopen rotator cuff repair with a structured conservative protocol for degenerative, nontraumatic full-thickness cuff tears. 56 patients were randomized and followed for 1 year with clinical scores and MRI. The question: does surgery beat conservative care for functional recovery?
When counseling a patient with a degenerative, atraumatic full-thickness cuff tear, this trial supports offering a structured conservative program first. At 1 year, functional scores were statistically indistinguishable, and even the significant pain and disability gains from surgery were small.
The key teaching point is that outcome tracks with repair integrity, not with the decision to operate. Patients whose repair stayed intact did best, but retear patients did no better than those never operated on. With a 73.7% retear rate here, that caveat carries weight, and side-to-side repairs (1 of 6 healed) reinforce preferring tendon-to-bone fixation.
This fits the broader evidence: two prior RCTs (Kukkonen, Moosmayer) also found differences below the clinically important threshold. The unsolved problem is prediction. Baseline age, CMS, retraction, and atrophy did not distinguish who would heal, so we cannot yet reliably select surgical candidates.