This Level I RCT randomized 103 patients with full-thickness rotator cuff tears ≤3 cm to primary repair or physiotherapy with optional secondary surgery. Blinded follow-up ran to 10 years, with 91 of 103 patients completing the study. The study answers whether early functional equivalence between treatments persists long-term — or whether surgery's advantage grows.
The debate over repair vs physiotherapy for small/medium rotator cuff tears had previously been settled only at 1-2 years, where outcomes look roughly equivalent — creating a reasonable argument for conservative-first management in all comers.
This paper changes that calculus for younger, active patients. The surgical advantage is real but small early on; by 10 years it becomes clinically meaningful across every functional domain.
When counseling an active patient in their 50s with a symptomatic ≤3 cm full-thickness tear, this study supports offering primary repair rather than a trial of physiotherapy with the option to operate later. Because that crossover penalty (10 Constant score points) is not recovered.
The retear data offers a useful reassurance: a retear on postoperative imaging does not mean failure. Those patients remain stable; it is the progressively enlarging unrepaired tear that drives long-term deterioration.
This Level I RCT randomized 103 patients with full-thickness rotator cuff tears ≤3 cm to primary repair or physiotherapy with optional secondary surgery. Blinded follow-up ran to 10 years, with 91 of 103 patients completing the study. The study answers whether early functional equivalence between treatments persists long-term — or whether surgery's advantage grows.
The debate over repair vs physiotherapy for small/medium rotator cuff tears had previously been settled only at 1-2 years, where outcomes look roughly equivalent — creating a reasonable argument for conservative-first management in all comers.
This paper changes that calculus for younger, active patients. The surgical advantage is real but small early on; by 10 years it becomes clinically meaningful across every functional domain.
When counseling an active patient in their 50s with a symptomatic ≤3 cm full-thickness tear, this study supports offering primary repair rather than a trial of physiotherapy with the option to operate later. Because that crossover penalty (10 Constant score points) is not recovered.
The retear data offers a useful reassurance: a retear on postoperative imaging does not mean failure. Those patients remain stable; it is the progressively enlarging unrepaired tear that drives long-term deterioration.