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Cederqvist S, Flinkkilä T, Sormaala M, Ylinen J, Kautiainen H, Irmola T, Lehtokangas H, Liukkonen J, Pamilo K, Ridanpää T, Sirniö K, Leppilahti J, Kiviranta I, Paloneva J. Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation. Ann Rheum Dis 2021; 80:796-802. [PMID: 33272959 PMCID: PMC8142425 DOI: 10.1136/annrheumdis-2020-219099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear. METHODS In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up. RESULTS At the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI -3 to 10, p=0.25) for pain and 3.4 (95% CI -0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery. CONCLUSIONS Non-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment. TRIAL REGISTRATION DETAILS ClinicalTrials.gov, NCT00695981 and NCT00637013.
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Affiliation(s)
- Sanna Cederqvist
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tapio Flinkkilä
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Markus Sormaala
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Hannu Kautiainen
- Research Center, Folkhälsan, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Tero Irmola
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Heidi Lehtokangas
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juho Liukkonen
- Department of Emergency Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Tero Ridanpää
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Kai Sirniö
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Juhana Leppilahti
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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