The Efficacy of Synovectomy in Rotator Cuff Repair: A Randomized Controlled Trial
Orthopaedic journal of sports medicine · 2026
Adding synovectomy to arthroscopic cuff repair showed no extra pain, motion, strength or satisfaction benefit at 3 months in this 60-patient RCT.
L’étude
RCT, n=60 patients with full-thickness rotator cuff tears undergoing arthroscopic repair, randomised to repair with (n=30) or without (n=30) synovectomy.
Ce qu’ils ont trouvé
Worst pain VAS improved significantly from baseline in both groups but with no between-group difference in magnitude of improvement (P=.79), and no significant differences at 3 months in any pain measure, range of motion, strength, functional scores or satisfaction. One nuance: supraspinatus strength fell significantly from baseline in the no-synovectomy group but not in the synovectomy group, though the between-group difference in that change was not itself significant, so it's a hint rather than a finding.
Type d’étude
Single-center randomized controlled trial (n=60) comparing arthroscopic rotator cuff repair with versus without synovectomy, in patients undergoing surgical repair and followed to 3 months; as an RCT this sits high on the therapeutic evidence hierarchy in principle, but the small sample and short horizon blunt that advantage here.
Méthodologie
Patients were randomised to synovectomy or no synovectomy with blinded outcome assessment, which limits detection bias on the pain, ROM, strength, function and satisfaction measures reported. The key weakness is that no power calculation is given for the primary outcome, so with only 60 patients split across two arms the trial may simply lack the sample size to detect a real between-group difference, meaning the null result reflects 'not proven' rather than 'proven absent.' Follow-up stops at 3 months, so attrition bias over a longer horizon and outcomes like retear rate can't be assessed, and allocation concealment, surgeon blinding (not plausible for this procedure) and funding/COI are not described in the available detail, all of which a clinician would need to check in the full text before treating the equivalence signal as solid. The supraspinatus strength finding in particular should be read as hypothesis-generating: it was a within-group pre-post comparison, not a significant between-group difference, so it wants confirmation with a formal interaction test in a larger trial rather than being taken as a real effect.
L’analyse
The trial supports 'no detectable early benefit' rather than proof of true equivalence: no power calculation is reported for the primary outcome, so a superiority design with only 60 patients can't reliably distinguish a true null from an underpowered one. That said, the consistency of the null result across six-plus outcome domains (pain, ROM, strength, function, satisfaction), combined with randomisation and blinded outcome assessment, makes a clinically meaningful early benefit from synovectomy look unlikely over the 3 months studied, even if the precision of that estimate can't be judged from the abstract alone.
La limite
No reported power calculation for the primary outcome and no data beyond 3 months, so whether synovectomy affects retear rates, long-term pain, or outcomes specifically in patients with severe synovitis remains unanswered.
Étude de référence
This builds on observational work linking synovitis on arthroscopy to worse cuff repair outcomes, and on synovectomy's established role in primary synovial disease (rheumatoid arthritis, PVNS); this appears to be among the first Level 1 RCTs to directly test synovectomy as an adjunct in cuff repair, rather than extrapolating from those indirect sources, though that primacy claim can't be fully verified from the abstract alone.
À appliquer dès lundi
This gives surgeons reasonable grounds to stop routinely adding synovectomy to arthroscopic cuff repair purely for early pain relief, since it adds operative time and risk without a demonstrated 3-month benefit, but it shouldn't be treated as the final word given the sample size and follow-up length. For the physio and S&C side of the team, the message is what doesn't change: rehab progression, ROM and strength milestones, and return-to-training timelines after cuff repair shouldn't be adjusted based on whether synovectomy was performed.
In practice
Whether or not synovectomy was performed, run the same standard graded ROM and strength progression after arthroscopic cuff repair, since neither pain, motion, strength, function nor satisfaction differed by technique at 3 months, don't tell patients synovectomy buys them a faster or less painful early recovery. The supraspinatus strength signal (declined only in the no-synovectomy arm, though not significantly different between groups) is reason enough to baseline and serially re-test cuff strength (Benchmark: shoulder External rotation / Internal rotation) through the first 3 months regardless of surgical technique, to catch a deficit early rather than assume one. For S&C coaches managing return-to-throw or return-to-lift after cuff repair, nothing here should shift RTS timelines or criteria, stay anchored to standard strength and function benchmarks rather than which intraoperative adjuncts were used. Caveat: this is 3-month data only from one trial, so it says nothing about retear rates, longer-term strength, or whether patients with severe synovitis specifically might respond differently.
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