Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation.

Autor:	Cederqvist S; Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland sanna.cederqvist@icloud.com., Flinkkilä T; Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland., Sormaala M; Department of Radiology, Helsinki University Hospital, Helsinki, Finland., Ylinen J; Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland., Kautiainen H; Research Center, Folkhälsan, Helsinki, Finland.; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland., Irmola T; Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland., Lehtokangas H; Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland., Liukkonen J; Department of Emergency Medicine, Central Finland Central Hospital, Jyväskylä, Finland., Pamilo K; Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland., Ridanpää T; Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland., Sirniö K; Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland., Leppilahti J; Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland., Kiviranta I; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.; Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland., Paloneva J; Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Jazyk:	angličtina
Zdroj:	Annals of the rheumatic diseases [Ann Rheum Dis] 2021 Jun; Vol. 80 (6), pp. 796-802. Date of Electronic Publication: 2020 Dec 03.
DOI:	10.1136/annrheumdis-2020-219099
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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