This single-center RCT randomized 103 patients with symptomatic small (<1 cm) or medium (1-3 cm) full-thickness rotator cuff tears to primary surgical repair or structured physiotherapy. The primary outcome was the Constant score at one year, assessed by a blinded examiner. It asks whether conservative management can match repair for these tears.
When a patient presents with a symptomatic small or medium full-thickness cuff tear and no absolute surgical indication, this trial says both surgery and physiotherapy are defensible first moves at one year. Primary repair gives measurably better shoulder-specific outcomes: a 13-point Constant edge, less pain, more abduction, and higher satisfaction.
But read the sensitivity analysis carefully. When the 18% who failed physiotherapy are counted by their eventual post-crossover surgical result, the advantage of upfront surgery falls to 7.7 points, which is only marginally relevant. Physiotherapy first, with surgery held in reserve, salvages most patients.
The caution is timing. Crossover patients did worse than primary repair after a 5-month delay, consistent with the principle that repair should precede retraction and atrophy. The one-year follow-up is the main limitation, since unrepaired tears may enlarge over time.
This single-center RCT randomized 103 patients with symptomatic small (<1 cm) or medium (1-3 cm) full-thickness rotator cuff tears to primary surgical repair or structured physiotherapy. The primary outcome was the Constant score at one year, assessed by a blinded examiner. It asks whether conservative management can match repair for these tears.
When a patient presents with a symptomatic small or medium full-thickness cuff tear and no absolute surgical indication, this trial says both surgery and physiotherapy are defensible first moves at one year. Primary repair gives measurably better shoulder-specific outcomes: a 13-point Constant edge, less pain, more abduction, and higher satisfaction.
But read the sensitivity analysis carefully. When the 18% who failed physiotherapy are counted by their eventual post-crossover surgical result, the advantage of upfront surgery falls to 7.7 points, which is only marginally relevant. Physiotherapy first, with surgery held in reserve, salvages most patients.
The caution is timing. Crossover patients did worse than primary repair after a 5-month delay, consistent with the principle that repair should precede retraction and atrophy. The one-year follow-up is the main limitation, since unrepaired tears may enlarge over time.