Abstract
Uncertainty exists regarding surgical management of patients with degenerative tears of the rotator cuff but its use is increasing substantially, particularly arthroscopic surgery. We aimed to assess the effectiveness of arthroscopic and open rotator cuff repair. 273 patients were recruited to a randomized comparison (136 to arthroscopic surgery and 137 to open surgery) from 19 teaching and district general hospitals in the UK. The surgeons used their usual and preferred method of repair. The Oxford Shoulder Score (OSS) at 24 months was the primary outcome measure. Imaging of the shoulder was performed at 12 months after surgery. The trial is registered with Current Controlled Trials, ISRCTN97804283.
The mean OSS improved from 26.3 (SD 8.2) at baseline to 41.7 (SD 7.9) at 24 months for arthroscopic surgery and from 25.0 (SD 8.0) to 41.5 (SD 7.9) for open surgery. Intention to treat analysis showed no statistical difference between the groups at 24 months (difference in OSS score = -0.76; 95% CI -2.75, 1.22; p=0.452). The confidence interval excluded the pre-determined clinically important difference in the OSS of three points. The rate of re-tear was not significantly different between the two groups (46.4% for arthroscopic and 38.6% for open surgery (95% CI -6.9, 25.8; p=0.256). Healed repairs had the most improved OSS. These findings were the same when analysed per-protocol.
There is no evidence of difference in effectiveness between open and arthroscopic repair. The rate of re-tear is high in both groups, for all tear sizes and ages and adversely affects outcomes.
The mean OSS improved from 26.3 (SD 8.2) at baseline to 41.7 (SD 7.9) at 24 months for arthroscopic surgery and from 25.0 (SD 8.0) to 41.5 (SD 7.9) for open surgery. Intention to treat analysis showed no statistical difference between the groups at 24 months (difference in OSS score = -0.76; 95% CI -2.75, 1.22; p=0.452). The confidence interval excluded the pre-determined clinically important difference in the OSS of three points. The rate of re-tear was not significantly different between the two groups (46.4% for arthroscopic and 38.6% for open surgery (95% CI -6.9, 25.8; p=0.256). Healed repairs had the most improved OSS. These findings were the same when analysed per-protocol.
There is no evidence of difference in effectiveness between open and arthroscopic repair. The rate of re-tear is high in both groups, for all tear sizes and ages and adversely affects outcomes.
Original language | English |
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Pages (from-to) | 107-115 |
Number of pages | 9 |
Journal | The Bone & Joint Journal |
Volume | 99-B |
Issue number | 1 |
DOIs | |
Publication status | Published - 4 Jan 2017 |
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Profiles
-
Craig Ramsay
- School of Medicine, Medical Sciences & Nutrition, Health Services Research Unit (HSRU) - Director of Health Services Research Unit
- Public Health, Health Services and Primary Care
- Institute of Applied Health Sciences
Person: Academic