We have compared three different methods of treating symptomatic non-traumatic tears of the supraspinatus tendon in patients above 55 years of age. A total of 180 shoulders (173 patients) with supraspinatus tendon tears were randomly allocated into one of three groups (each of 60 shoulders); physiotherapy (group 1), acromioplasty and physiotherapy (group 2) and rotator cuff repair, acromioplasty and physiotherapy (group 3). The Constant score was assessed and followed up by an independent observer pre-operatively and at three, six and twelve months after the intervention.

Of these, 167 shoulders were available for assessment at one year (follow-up rate of 92.8%). There were 55 shoulders in group 1 (24 in males and 31 in females, mean age 65 years (55 to 79)), 57 in group 2 (29 male and 28 female, mean age 65 years (55 to 79)) and 55 shoulders in group 3 (26 male and 29 female, mean age 65 years (55 to 81)). There were no between-group differences in the Constant score at final follow-up: 74.1 (sd 14.2), 77.2 (sd 13.0) and 77.9 (sd 12.1) in groups 1, 2 and 3, respectively (p = 0.34). The mean change in the Constant score was 17.0, 17.5, and 19.8, respectively (p = 0.34). These results suggest that at one-year follow-up, operative treatment is no better than conservative treatment with regard to non-traumatic supraspinatus tears, and that conservative treatment should be considered as the primary method of treatment for this condition.

Cite this article: Bone Joint J 2014;96-B:75–81.

Aims: Wood is a product of nature, has a structural architecture resembling bone and is chemically polymer-like. Birchwood modified with heat and humid air was selected to study its possibilities for bone reconstruction. Methods: Bulk birchwood was prepared for 2–3 hours at temperature of 220°C in humid air, this modifies the wood chemically and physically. 16 cone shaped implants 7x4 mm in size were carved from the heat treated material (Bioactive Wood Bone, BWB) and implanted by press-fit technique into holes drilled in the distal femurs of rabbits. Untreated cones served as controls. The resected knees were embedded in plastic (Techmont, Kulzer GmBH). For evaluation histology, histomorfometry and scanning electron microscopy (SEM) were carried out. Results: In vitro SEM showed the canal structures of the wood. In vivo no articular hydrops or wound infections were seen. At 4 and 8 weeks an inflammatory cellular reaction of a mild degree with some histiocytes was observed. At 8 and 20 weeks the implant’s surface was in connection with the surrounding bone and connective tissue. Bone-implant contact at the interface required proper press-fit technique. At 8 and 20 weeks histometry revealed new bone growth covering 21% (mean, range 6–41%) of the implant surface resembling the osteoconductive bonding characteristic of biomaterials. Conclusions: Modified heat treated wood showed biocompatibility and osteoconductivity in cancellous bone defect. A bone bonding-like-phenomenon observed at the interface between the birch implant and bone illustrates it’s potentials for use as a bone substitute.