TY - JOUR
T1 - Comparative Effectiveness of Operative Versus Nonoperative Treatment for Rotator Cuff Tears
T2 - A Propensity Score Analysis From the ROW Cohort
AU - Jain, Nitin B.
AU - Ayers, Gregory D.
AU - Fan, Run
AU - Kuhn, John E.
AU - Warner, Jon J.P.
AU - Baumgarten, Keith M.
AU - Matzkin, Elizabeth
AU - Higgins, Laurence D.
N1 - Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: N.B.J. has received funding from the National Institutes of Health (grants U34AR069201 and 1K23AR059199 and Clinical and Translational Science Award No. UL1TR000445). J.J.P.W. has received education payments from Arthrex; consulting fees from Wright Medical Technology, DePuy, and Tornier; hospitality payments from Arthrex, Smith & Nephew, and Tornier; and royalty or license fees from Wright Medical Technology and Tornier. K.M.B. has received consulting fees from Wright Medical Group and educational support from Arthrex. E.M. has received educational support from NuVasive, Arthrex, and Smith & Nephew and consulting fees from Smith & Nephew. L.D.H. has received educational support from Arthrex and Ethicon and is now employed by Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Funding Information:
The authors thank the entire ROW team for their efforts. The authors also thank the clinical staff at the Orthopaedic & Arthritis Center at Brigham and Women’s Hospital, the Shoulder Service at Massachusetts General Hospital, and the clinical staff at Vanderbilt Orthopaedic Institute for their efforts and cooperation.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Background: The evidence to support operative versus nonoperative treatment for rotator cuff tears is sparse and inconclusive. Purpose: To assess pain and functional outcomes in patients undergoing operative and nonoperative treatments for rotator cuff tears. Study Design: Cohort study; Level of evidence, 3. Methods: From March 2011 to February 2015, a multicenter cohort of patients with rotator cuff tears undergoing operative and nonoperative treatments was recruited. Patients completed a detailed history questionnaire, the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons (ASES) standardized form and underwent magnetic resonance imaging. In addition to baseline assessments, patients received follow-up questionnaires at 3, 6, 12, and 18 months. Propensity score weighting was used to balance differences in characteristics of the operative and nonoperative groups. Results: Adjusted for propensity scores, the operative (n = 50) and nonoperative (n = 77) groups had similar characteristics, as evidenced by the small standardized mean differences between the groups. Adjusted mean differences in the SPADI and ASES scores between the operative and nonoperative groups were –22.0 points (95% CI, –32.1 to –11.8) and –22.2 points (95% CI, –32.8 to –11.6) at 18 months, respectively. The operative group had a significantly higher proportion of patients who showed ≥30% (P =.002) and ≥50% (P <.0001) improvement in SPADI and ASES scores as compared with the nonoperative group. Conclusion: In this prospective cohort study, patients undergoing operative treatment had significantly better pain and functional outcomes as compared with patients undergoing nonoperative treatment for rotator cuff tears. Differences between the 2 groups in SPADI and ASES scores at the 6- to 18-month time points met the minimal clinically important difference (depending on the threshold used). A large randomized controlled trial is needed to answer this question more definitively.
AB - Background: The evidence to support operative versus nonoperative treatment for rotator cuff tears is sparse and inconclusive. Purpose: To assess pain and functional outcomes in patients undergoing operative and nonoperative treatments for rotator cuff tears. Study Design: Cohort study; Level of evidence, 3. Methods: From March 2011 to February 2015, a multicenter cohort of patients with rotator cuff tears undergoing operative and nonoperative treatments was recruited. Patients completed a detailed history questionnaire, the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons (ASES) standardized form and underwent magnetic resonance imaging. In addition to baseline assessments, patients received follow-up questionnaires at 3, 6, 12, and 18 months. Propensity score weighting was used to balance differences in characteristics of the operative and nonoperative groups. Results: Adjusted for propensity scores, the operative (n = 50) and nonoperative (n = 77) groups had similar characteristics, as evidenced by the small standardized mean differences between the groups. Adjusted mean differences in the SPADI and ASES scores between the operative and nonoperative groups were –22.0 points (95% CI, –32.1 to –11.8) and –22.2 points (95% CI, –32.8 to –11.6) at 18 months, respectively. The operative group had a significantly higher proportion of patients who showed ≥30% (P =.002) and ≥50% (P <.0001) improvement in SPADI and ASES scores as compared with the nonoperative group. Conclusion: In this prospective cohort study, patients undergoing operative treatment had significantly better pain and functional outcomes as compared with patients undergoing nonoperative treatment for rotator cuff tears. Differences between the 2 groups in SPADI and ASES scores at the 6- to 18-month time points met the minimal clinically important difference (depending on the threshold used). A large randomized controlled trial is needed to answer this question more definitively.
KW - arthroscopic surgery
KW - nonoperative
KW - rotator cuff tears
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U2 - 10.1177/0363546519873840
DO - 10.1177/0363546519873840
M3 - Article
C2 - 31518155
AN - SCOPUS:85073979256
SN - 0363-5465
VL - 47
SP - 3065
EP - 3072
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 13
ER -