After a rotator cuff tear, suturing usually pays off in the long run. Prof. Felix Zeifang from the University Hospital in Heidelberg reported at the Ortho Update on a recent trend reversal in the treatment of shoulder tendon tears.
Last year, there was a 180° turnaround in recommendations for rotator cuff tears. While it was previously assumed that success rates of up to 75% could be achieved with purely physiotherapy treatment (Kuhn et al., JSES 2013), experts now have to admit that these hopes were probably premature.
According to the shoulder expert, the current study by Stefan Moosmayer (JBJS 2019) with a total of 103 participants provides insight into how patients fare in the long term: After ten years of follow-up, tendon suture was significantly superior to physiotherapy alone for small to medium-sized ruptures, both in terms of strength and pain.
The results were initially similar, but after a few years the curves diverged significantly. What also became clear was that the non-operated ruptures increased in size over time. In the conservatively treated group, 41% of patients showed a tear enlargement of more than 1 cm over the course of the study. 27% ultimately required surgery.
These findings published by Prof. Zeifang fully correspond to our current recommendations for our patients and reaffirm our approach to treatment decision-making.