Prognostic Outcomes Between Conservative and Surgical Interventions in Patients with Full-Thickness Rotator Cuff Tears

Abstract

Context: Full-thickness rotator cuff tears are one of the most common musculoskeletal conditions affecting a variety of patient populations. This condition, if not treated, leads to increased pain, reduced functional abilities, and reduced efficiency with activities of daily living all culminating into decreasing the patient’s overall quality of life. Surgical repair is generally the standard of care for these patients; however, new evidence suggests that conservative treatment may be just as effective.

Objective: The aim of this systematized review was to describe measurable outcomes (pain, mobility, and strength) and how they compare surgical treatment compared to conservative treatment in full-thickness tear rotator cuff patients.

Design: A systematized review of the current literature from 2015-2025, assessing the prognostic outcomes of both conservative and surgical methods of treatment of full-thickness rotator cuff tears.

Eligibility Criteria: Adults ≥30 years old diagnosed with full-thickness rotator cuff tears confirmed by imaging; full thickness rotator cuff tear (supraspinatus, infraspinatus, teres minor, subscapularis); Interventions (Surgical repair: Mini open repair, arthroscopic repair, open repair, injections. Conservative (non-surgical): Physical Therapy Protocol and exercise interventions); Outcomes: Constant-Murley Score (CMS), ASES, Quick-DASH, MMT, ROM.

Study Selection: 16 out of 887 initial studies met all the inclusion criteria.

Results: Both interventions demonstrated effective progress in overall condition. Surgical interventions demonstrated faster improvement with significant improvement in functional scores occurring at 6-12 months followed by a plateau where both intervention groups would produce similar functional scores after one year. Tear size and level of symptoms were the most significant indicators for patient success. Tears that were not classified as “large” demonstrated consistent and non-variable progress regardless of method used.

Conclusion: Both methods of interventions provide significant clinical results with surgical groups demonstrating progress at 6-12 months while conservative groups reached the same functional scores in the long term. Overall, conservative treatment was able to produce similar outcomes for tears that were classified as small to medium demonstrating its effectiveness with this patient population. These results suggest a patient centered/stepwise approach would be most effective for patients with small to medium tears. This means incorporating patient factors with an initial conservative approach followed by surgical intervention if the conservative treatment has not improved overall patient condition. Larger tears, however, should directly receive surgical intervention due to its variability in presentation and outcomes.