Objectives: Comparative time to recovery after surgical and non-operative treatments for rotator cuff tears is an important consideration for patients. Our objective was to compare the time to achieve clinically meaningful improvement in shoulder pain and function after surgical and non-operative treatments for rotator cuff tears.
Designs: From February 2011 to June 2015, a multi-center cohort of patients with rotator cuff tears undergoing surgery and non-operative treatment was recruited. After propensity score weighting, the Kaplan-Meier method was used to estimate the time to achieve minimal clinically important difference (MCID), > 30% improvement, and > 50% improvement in Shoulder Pain and Disability Index (SPADI) and American Shoulder and Elbow Surgeons (ASES) scores. A two-stage test was conducted to detect a difference between the two groups. Statistical tests, with multiplicity control, were calculated for maximal differences between time-to-event distributions.
Results: In this cohort, 96 patients underwent non-operative treatment and 73 patients had surgery. The surgical and non-operative groups were significantly different for SPADI and ASES (p < 0.05). The maximum difference between groups to achieve SPADI MCID was at 3.25 months favoring the non-operative group (p = 0.00012). The surgery group had a greater probability to achieve > 50% improvement in both SPADI (15.49 months; p = 0.00019) and ASES (24.74 months; p = 0.00003). Differences for > 30% improvement in SPADI and ASES, and ASES MCID were not significant.
Patients receiving non-operative treatment had significantly better outcomes in the initial follow-up period as compared with the surgery group but this trend reversed in the longer term. This data can be used to inform expectations from non-operative versus surgical treatment for rotator cuff tears.
Amos Song– Resident Physician, Vanderbilt University Medical Center
Joshua DeClercq– Biostatistician, Department of Biostatistics, Vanderbilt University School of Medicine
Gregory Ayers– Biostatistician, Department of Biostatistics, Vanderbilt University School of Medicine
John Kuhn– Physician, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center
Laurence Higgins– Physician, King Edward Memorial Hospital
Elizabeth Matzkin– Physician, Brigham and Women's Hospital
Keith Baumgarten– Physician, Orthopedic Institute of Sioux Falls
Nitin Jain– Physician, Vanderbilt University Medical Center