Strong evidence supports that both physical therapy and operative treatment result in significant improvement in patient-reported outcomes for patients with symptomatic small to medium full-thickness rotator cuff tears.

Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA
Strong Evidence STRONG EVIDENCE
Rationale
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.
  1. Moosmayer, S, Lund, G, Seljom, Us, Haldorsen, B, Svege, Ic, Hennig, T, Pripp, Ah, Smith, Hj Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up. The Journal of bone and joint surgery. American volume 2014; 18: 1504-14
  2. Kukkonen, J., Joukainen, A., Lehtinen, J., Mattila, K. T., Tuominen, E. K. J., Kauko, T., �ärimaa, V. Treatment of nontraumatic rotator cuff tears: A randomized controlled trial with two years of clinical and imaging follow-up. Journal of Bone and Joint Surgery - American Volume 2015; 21: 1729-1737