PMID- 32618921 OWN - NLM STAT- MEDLINE DCOM- 20210223 LR - 20221005 IS - 1535-1386 (Electronic) IS - 0021-9355 (Print) IS - 0021-9355 (Linking) VI - 102 IP - 13 DP - 2020 Jul 1 TI - Comparative Time to Improvement in Nonoperative and Operative Treatment of Rotator Cuff Tears. PG - 1142-1150 LID - 10.2106/JBJS.19.01112 [doi] AB - BACKGROUND: Comparative time to recovery after operative and nonoperative treatment for rotator cuff tears is an important consideration for patients. Hence, we compared the time to achieve clinically meaningful reduction in shoulder pain and function after treatment. METHODS: From February 2011 to June 2015, a multicenter cohort of patients with rotator cuff tears undergoing operative or nonoperative treatment was recruited. After propensity score weighting, the Kaplan-Meier method was used to estimate the time to achieve a minimal clinically important difference (MCID), >30% reduction, and >50% reduction in the Shoulder Pain and Disability Index (SPADI) and the American Shoulder and Elbow Surgeons (ASES) scores. (In our analysis, both ASES and SPADI were coded such that a lower number corresponded to a better outcome; thus, the word "reduction" was used to indicate improvement in both ASES and SPADI scores.) A 2-stage test was conducted to detect a difference between the 2 groups. RESULTS: In this cohort, 96 patients underwent nonoperative treatment and 73 patients underwent a surgical procedure. The surgical treatment group and the nonoperative treatment group were significantly different with respect to SPADI and ASES scores (p < 0.05). The maximum difference between groups in achievement of the MCID for the SPADI scores was at 3.25 months, favoring the nonoperative treatment group. The probability to achieve the MCID was 0.06 (95% confidence interval [CI], 0.00 to 0.12) for the surgical treatment group compared with 0.40 (95% CI, 0.29 to 0.50) for the nonoperative treatment group. The surgical treatment group had a greater probability of achieving >50% reduction in SPADI scores at 15.49 months (0.20 [95% CI, 0.12 to 0.29] for the surgical treatment group compared with 0.04 [95% CI, 0.00 to 0.09] for the nonoperative treatment group). The surgical treatment group had a greater probability of achieving >50% reduction in ASES scores at 24.74 months (0.96 [95% CI, 0.84 to 0.99] for the surgical treatment group compared with 0.66 [95% CI, 0.53 to 0.75] for the nonoperative treatment group). The differences for >30% reduction in SPADI and ASES scores and the MCID for ASES scores were not significant. CONCLUSIONS: Patients undergoing nonoperative treatment had significantly better outcomes in the initial follow-up period compared with patients undergoing a surgical procedure, but this trend reversed in the longer term. These data can be used to inform expectations for nonoperative and operative treatments for rotator cuff tears. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. FAU - Song, Amos AU - Song A AUID- ORCID: 0000-0001-9708-5618 AD - Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee. FAU - DeClercq, Joshua AU - DeClercq J AUID- ORCID: 0000-0002-8171-5766 AD - Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee. FAU - Ayers, Gregory D AU - Ayers GD AUID- ORCID: 0000-0002-0892-350 AD - Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee. FAU - Higgins, Laurence D AU - Higgins LD AUID- ORCID: 0000-0001-6694-2680 AD - King Edward Memorial Hospital, Hamilton, Bermuda. FAU - Kuhn, John E AU - Kuhn JE AUID- ORCID: 0000-0001-6873-3380 AD - Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee. FAU - Baumgarten, Keith M AU - Baumgarten KM AUID- ORCID: 0000-0003-2929-1027 AD - Orthopedic Institute of Sioux Falls, Sioux Falls, South Dakota. FAU - Matzkin, Elizabeth AU - Matzkin E AUID- ORCID: 0000-0001-8592-7187 AD - Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. FAU - Jain, Nitin B AU - Jain NB AUID- ORCID: 0000-0002-4362-8522 AD - Departments of Physical Medicine and Rehabilitation (A.S. and N.B.J.), Orthopaedics and Rehabilitation (N.B.J. and J.E.K.), and Biostatistics (J.D. and G.D.A.), Vanderbilt University Medical Center, Nashville, Tennessee. LA - eng GR - K23 AR059199/AR/NIAMS NIH HHS/United States GR - U34 AR069201/AR/NIAMS NIH HHS/United States PT - Comparative Study PT - Journal Article PL - United States TA - J Bone Joint Surg Am JT - The Journal of bone and joint surgery. American volume JID - 0014030 SB - IM CIN - J Bone Joint Surg Am. 2020 Jul 1;102(13):e72. PMID: 32618928 MH - Aged MH - Female MH - Humans MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Physical Therapy Modalities MH - Recovery of Function/*physiology MH - Rotator Cuff/diagnostic imaging/*surgery MH - Rotator Cuff Injuries/diagnostic imaging/surgery/*therapy MH - Shoulder Pain/diagnostic imaging/surgery/*therapy MH - Time Factors MH - Treatment Outcome PMC - PMC7508291 EDAT- 2020/07/04 06:00 MHDA- 2021/02/24 06:00 PMCR- 2021/07/01 CRDT- 2020/07/04 06:00 PHST- 2020/07/04 06:00 [entrez] PHST- 2020/07/04 06:00 [pubmed] PHST- 2021/02/24 06:00 [medline] PHST- 2021/07/01 00:00 [pmc-release] AID - 00004623-202007010-00015 [pii] AID - JBJS-D-19-01112 [pii] AID - 10.2106/JBJS.19.01112 [doi] PST - ppublish SO - J Bone Joint Surg Am. 2020 Jul 1;102(13):1142-1150. doi: 10.2106/JBJS.19.01112.