This is the 15-year report of a Level I RCT comparing primary tendon repair with physiotherapy for small-to-medium full-thickness rotator cuff tears (≤3 cm). 103 patients were randomized, with physiotherapy patients allowed to cross over to surgery. It asks whether the outcome gap seen at 5 and 10 years continues to widen out to 15 years.
When you counsel a patient with a small-to-medium full-thickness cuff tear, the honest message is that both paths improve on baseline, but primary repair gives better shoulder function that pulls further ahead over time.
The driver is not that surgery gets better; it is that unrepaired tears enlarge and function slips. Mean tear size nearly doubled over 15 years, and Constant scores fell from 78.8 to 63.7.
The practical middle ground is real: most physiotherapy patients avoided surgery, and the ~29% who crossed over caught back up to the primary repair group. So a trial of physiotherapy with a clear plan to reassess and repair if it fails is a defensible strategy, not a wasted delay.
Repair integrity matters too, since intact repairs outperformed retears. Follow nonoperatively managed tears over time, because roughly half widen.
This is the 15-year report of a Level I RCT comparing primary tendon repair with physiotherapy for small-to-medium full-thickness rotator cuff tears (≤3 cm). 103 patients were randomized, with physiotherapy patients allowed to cross over to surgery. It asks whether the outcome gap seen at 5 and 10 years continues to widen out to 15 years.
When you counsel a patient with a small-to-medium full-thickness cuff tear, the honest message is that both paths improve on baseline, but primary repair gives better shoulder function that pulls further ahead over time.
The driver is not that surgery gets better; it is that unrepaired tears enlarge and function slips. Mean tear size nearly doubled over 15 years, and Constant scores fell from 78.8 to 63.7.
The practical middle ground is real: most physiotherapy patients avoided surgery, and the ~29% who crossed over caught back up to the primary repair group. So a trial of physiotherapy with a clear plan to reassess and repair if it fails is a defensible strategy, not a wasted delay.
Repair integrity matters too, since intact repairs outperformed retears. Follow nonoperatively managed tears over time, because roughly half widen.