Commentary & Perspective How Much Benefit Do We Get from Rotator Cuff Repair? Commentary on an article by Stefan Moosmayer, MD, PhD, et al.: “Tendon Repair Compared with Physiotherapy in the Treatment of Rotator Cuff Tears. A Randomized Controlled Study i

Randomized controlled trials are difficult to conduct, explaining their paucity in the literature on the management of rotator cuff disease and the difficulty in establishing definitive guidelines for treatment. This study by Moosmayer and colleagues represents one of the few randomized trials on patients with rotator cuff tears that compares surgical repair with nonoperative treatment. Although rotator cuff surgery is increasing in frequency, this study should be troubling to surgeons as the amount of improvement obtained with surgery is not great compared with a standard exercise program and, in fact, the gains in the Constant score are below the threshold for a clinically important difference. It is also interesting to note that the failure of treatment for the two groups was similar. Of the fifty-one patients randomized to physiotherapy, nonoperative treatment was successful in 76 % (thirty-nine patients) and unsuccessful in 24 % (twelve patients) if failure is defined as crossing over to surgery. For sixty of the sixty-four patients treated with a rotator cuff repair, assessment of the integrity of the tendon was performed by sonography after five years, and postoperative imaging demonstrated complete healing in 75 % (forty-five patients), with partial failure in 12 % (seven patients) and complete failure in 13 % (eight patients). There were several limitations of this study. First, the authors report that, of the fifty-two cases in the primary tendon repair group, eighteen (35%) had a concomitant biceps tenodesis performed in addition to the rotator cuff repair. Unfortunately, this introduces considerable performance bias into the study. It is reasonable to expect that at least some of the improvement in outcomes in the primary tendon repair groupmay be related to the treatment of the biceps tendon and not to the rotator cuff repair