Long-term Comparative Effectiveness of Surgical Versus Non-surgical Treatment for Rotator Cuff Tears: 5-Year Follow-up of a Prospective Cohort Study 8265

Abstract

Objectives

To investigate the long-term effect of operative versus conservative treatments for rotator cuff tears (RCTs), because insufficient long-term evidence exists for the decision-making process.

Design

A multicenter prospective longitudinal cohort study with a follow-up of over 5 years. Follow-up visits were set at 3, 6, 12, 18, 24, 36, 48, and 60 months. Inverse probability weighting was used to balance differences in baseline characteristics of the operative and nonoperative groups. Generalized linear mixed model and 3-way interaction were applied in the main and subgroup analysis.

Setting

Sports or shoulder clinics in 3 academic settings and 1 community setting between March 2011 and February 2015.

Participants

Patients over 45 years of age who were diagnosed with RCTs.

Interventions

Not applicable because it is a prospective cohort study.

Main Outcome Measures

Assessments included the Shoulder Pain and Disability Index, the American Shoulder and Elbow Surgeons form, magnetic resonance imaging, and a detailed health history questionnaire.

Results

After Inverse probability weighting, both groups (operative, n=50; nonoperative, n=77) displayed similar baseline demographics. Outcomes were comparable between groups until 18 months after intervention. Beyond this period, the operative group demonstrated significantly improved outcomes in both Shoulder Pain and Disability Index and American Shoulder and Elbow Surgeons scores. Adjusted mean differences in Shoulder Pain and Disability Index scores were −11.6 (95% confidence interval [CI], −23.3 to 0.137; P=.0527) at 12 months, −12.75 (95% CI, −22.6 to −2.957; P=.0107) at 18 months, and −9.48 (95% CI, −14.5 to −4.41; P<.0001) at the 5-year mark. Subgroup analyses revealed that women (P=.0126) and patients with traumatic RCTs (P<.0001) benefitted more from surgical interventions than from nonoperative treatment.

Conclusions

Surgical intervention for RCTs leads to more substantial functional improvement than nonoperative methods after 18 months and remains stable up to 5 years. Female patients and those with traumatic RCTs are more likely to experience better long-term functional outcomes after surgery. This research provides insights into recovery timelines, which can support patient-centered decision making.

Disclosures

none.