Management of Small to Medium Tears

Two prospective randomized controlled trials comparing physical therapy to operative repair for treatment of small to medium rotator cuff tears showed substantial improvement in patient reported outcomes (PROs)and strength over time; however, there were no clinically meaningful difference in PROs between the groups. (Moosmayer, 2014, Kukkonen 2015) At 5-year follow up, Moosmayer, et.al., reported that the results of primary repair were superior to physical therapy, with the mean group differences of 5.3 for the Constant score (p=0.05) and 9.0 for the ASES score (p<0.001); however, the differences in PROs were below the accepted minimal clinically important difference. (Moosmayer 2014) Both physical therapy and operative repair groups demonstrated clinically meaningful improvement from baseline in the Constant score, ASES score, SF-36 score, and strength. (Moosmayer 2014) At 2-years, Kukkonen, et.al., reported no significant (p=0.38) differences in the mean change of the Constant score between physical therapy and repair, both treatments resulted in substantial clinical improvement from pre-to-post treatment. (Kukkonen 2015)

Risks and Harms of Implementing this Recommendation
There are no harms in associated in implementing this recommendation. There were no reported statistical differences between primary or secondary repair, when physical therapy fails (p=0.23). (Moosmayer S 2014)

Future Research
Continued comparative studies between physical therapy and surgical repair investigating larger tear sizes and modern approaches and fixation methods. The studies need to continue beyond 5-years to fully understand the true efficacy of each treatment.