Degenerative full thickness rotator cuff tears:Towards optimal management

The shoulder is one of the most complex joints in the body. Besides a wide range of motion it also has to be stable. The rotator cuff is a major stabiliser of the glenohumoral joint. With increasing age rotator cuff tears are common. Successful treatment is described following surgical (rotator cuff repair) and conservative treatment. The aim of this thesis is to optimise management of degenerative rotator cuff tears. A randomised controlled trial was performed to compare both treatment modalities. At the one yearly follow up in all included patients standardized functional outcome scores were taken. In our population of patients we found at one year no significant differences in functional outcome scores. The best scores were found in the group of patients with an intact rotator cuff following repair. However, in 73% of patients treated surgically a retear was found. MRI assesment of the rotator cuff tear was commenced at inclusion and one year following treatment. We found during one year of conservative treatment no increase in tear size or other degenerative changes that could influence cuff reparability if conservative treatment would fail. This finding do not support the theory that early rotator cuff repair should be performd to prevent increase in tear size and other degenerative changes that would influence cuff repairability. A systematic review was performed to identify prognostic factors for rotator cuff repair. Surgical repair should be carefully considered in patients in older age groups, with multipele tendon involvement and greater tear sizes