Shoulder surgeons across the UK have been unsure whether keyhole or open surgery better repairs torn rotator cuff muscles, or whether rest and exercise alone is enough. The rotator cuff—a group of muscles controlling shoulder movement—is one of the most common sources of shoulder pain and disability, yet the evidence for how best to treat tears is limited and contradictory. This trial will randomise over 600 patients from 70 UK centres to arthroscopic repair, open repair, or a rest-then-exercise programme. Researchers will track shoulder pain and function through patient questionnaires, measure healthcare costs including hospital stays and equipment, and use MRI scans at 12 months to check whether surgical repairs remain intact. Tissue samples taken during surgery will also be analysed to see whether the quality of the tendon tissue influences success. If the trial shows one approach clearly outperforms the others, it could settle a long-running clinical debate and give the NHS a definitive, cost-effective treatment pathway for one of the most common shoulder problems seen in orthopaedic clinics.
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The rotator cuff is a group of muscles that control movements within the shoulder. Tears of the rotator cuff are one of the most common causes of shoulder pain and dysfunction. The clinical evidence available regarding the natural history and the treatment of rotator cuff tears is limited and conflicting. Different methods of rotator cuff tear management are practiced throughout the United Kingdom. These include: ArthroscopicRepair - where the tear is repaired through key-hole surgery Open Repar - involving a longer skin incision to undertake the procedure under direct vision Non-Surgical Treatment - where a programme of Rest then Exercise is practiced This study was designed to assess these three methods of treatment. We will investigate over 600 patients, from 70 centres through out the United Kingdom. Information to be collected and analysed includes: Patient focused questionnaires regarding shoulder pain and function Patient focused questionnaires regarding the economic cost of the treatment Health care resources used (i.e. hospital stays, operating theatre equipment) MRI scans 12 months after the surgical repairs (to see if the repair is intact) Histological findings from tissue samples harvested during surgical repairs (to see if tissue quality influences success) Patients will be introduced to the trial by their consultant orthopaedic surgeon at his/her out-patient clinic. Patients who are interested will then receive information regarding UKUFF from the Oxford Trial office. Those who consent to participate will be randomised to undergo an arthroscopic repair or an open repair, or to complete the rest then exercise programme. All participating patients will be placed on the NHS waiting list for surgery. Those allocated to the Rest then Exercise programme will still be placed on the waiting list. However if they feel their shoulder has improved after completing the programme, they can decline surgery. A free-phone helpline will be established so patients have easy access to communicate with members of the research team in Oxford.
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