This 2-center Level I RCT is the first prospective randomized study focused exclusively on acute traumatic rotator cuff tears in previously symptom-free patients. It randomized 58 patients with small full-thickness supraspinatus tears (median sagittal size ~1 cm) to either early surgical repair or structured physiotherapy. The primary question: does repair produce better 12-month functional outcomes than physiotherapy alone?
Prior RCTs comparing repair to physiotherapy enrolled mostly degenerative tears, leaving a gap in evidence for the patient who tears a healthy tendon after a clear traumatic event. Surgeons commonly assumed that a traumatic tear — unlike a degenerative one. Was a stronger indication for repair.
This trial challenges that assumption. When a patient with no prior shoulder complaints sustains a small supraspinatus tear (under ~2 cm sagittally), a structured physiotherapy program produces 12-month outcomes indistinguishable from surgery. You do not need to rush to the OR.
However, tell patients choosing nonoperative care that roughly 1 in 3 will have measurable tear enlargement on MRI by one year. The clinical relevance of that progression beyond 12 months is unknown from this trial, and a 10-year follow-up of a related RCT showed the unrepaired group eventually deteriorated.
The practical decision rule: for small acute traumatic tears, offer structured physiotherapy first, obtain a follow-up MRI, and revisit repair if there is clinical deterioration or progressive enlargement.
This 2-center Level I RCT is the first prospective randomized study focused exclusively on acute traumatic rotator cuff tears in previously symptom-free patients. It randomized 58 patients with small full-thickness supraspinatus tears (median sagittal size ~1 cm) to either early surgical repair or structured physiotherapy. The primary question: does repair produce better 12-month functional outcomes than physiotherapy alone?
Prior RCTs comparing repair to physiotherapy enrolled mostly degenerative tears, leaving a gap in evidence for the patient who tears a healthy tendon after a clear traumatic event. Surgeons commonly assumed that a traumatic tear — unlike a degenerative one. Was a stronger indication for repair.
This trial challenges that assumption. When a patient with no prior shoulder complaints sustains a small supraspinatus tear (under ~2 cm sagittally), a structured physiotherapy program produces 12-month outcomes indistinguishable from surgery. You do not need to rush to the OR.
However, tell patients choosing nonoperative care that roughly 1 in 3 will have measurable tear enlargement on MRI by one year. The clinical relevance of that progression beyond 12 months is unknown from this trial, and a 10-year follow-up of a related RCT showed the unrepaired group eventually deteriorated.
The practical decision rule: for small acute traumatic tears, offer structured physiotherapy first, obtain a follow-up MRI, and revisit repair if there is clinical deterioration or progressive enlargement.