Rotator Cuff Repair: What Makes It Worthwhile? Patients Have a Number…and It’s Big
Jul 01, 2025
When it comes to rotator cuff surgery, we often ask: “Does it work?”
But a better question might be: “How much better than non-surgical treatment does it need to be for patients to say it’s worth it?”
A 2025 study by Hansford et al. used a benefit-harm trade-off method to answer that. Patients with persistent shoulder pain were asked how much improvement in pain and function they’d require from surgery (compared to non-surgical care) to make it worthwhile.
The median answer?
A 40% improvement, equivalent to 28 points on the WORC Index.
That’s a high bar.
Now zoom out to the broader evidence base. A 2019 systematic review and meta-analysis by Karjalainen et al. showed that rotator cuff repair surgery offers only small, often clinically insignificant, improvements over non-surgical treatment. Certainly not 40% better.
This discrepancy matters.
It tells us two things:
- We should rethink default surgical pathways for rotator cuff-related pain.
- We must integrate patient-defined thresholds, like the smallest worthwhile effect, into decision-making.
Surgery can help, but does it help enough to justify the risks, costs, and recovery?
A small benefit may not be enough, according to the stakeholders that really matter, people with shoulder pain.
References
Hansford et al. https://pubmed.ncbi.nlm.nih.gov/40500773/
Karjalainen et al. https://pubmed.ncbi.nlm.nih.gov/31813166/
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