Jennifer C. Seida, MPH; Claire LeBlanc, MD; Janine R. Schouten, BSc; Shima S. Mousavi, MD; Lisa Hartling, PhD; Ben Vandermeer, MSc; Lisa Tjosvold, MLIS; David M. Sheps, MD, MSc
Seida JC, LeBlanc C, Schouten JR, Mousavi SS, Hartling L, Vandermeer B, et al. Systematic Review: Nonoperative and Operative Treatments for Rotator Cuff Tears. Ann Intern Med. 2010;153:246-255. doi: 10.7326/0003-4819-153-4-201008170-00263
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Published: Ann Intern Med. 2010;153(4):246-255.
Many approaches exist for managing rotator cuff tears.
To compare the benefits and harms of nonoperative and operative interventions on clinically important outcomes in adults with rotator cuff tears.
12 electronic databases (1990 to September 2009), gray literature, trial registries, and reference lists were searched.
Controlled and uncontrolled studies that assessed nonoperative or operative treatments or postoperative rehabilitation for adults with confirmed rotator cuff tears were included. Operative studies in English-language publications and nonoperative and postoperative rehabilitation studies in English, French, or German were considered. Studies were assessed in duplicate.
2 reviewers assessed risk for bias by using the Cochrane Risk of Bias tool and the Newcastleâ€“Ottawa Scale. One reviewer rated the evidence by using a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Data were extracted by one reviewer and verified by another.
137 studies met eligibility criteria. All trials had high risk for bias. Cohort and uncontrolled studies were of moderate quality. Reported functional outcomes did not differ between open versus mini-open repair, mini-open versus arthroscopic repair, arthroscopic repair with versus without acromioplasty, or single-row versus double-row fixation. Earlier return to work was reported for mini-open repair versus open repair and for continuous passive motion with physical therapy versus physical therapy alone. Open repairs showed greater improvement in function than did arthroscopic debridement. Complication rates were low across all interventions.
Limited evidence, which was often of low quality, precluded conclusions for most comparisons. Language restrictions may have excluded some relevant studies, and selective outcome reporting may have introduced bias.
Evidence on the comparative effectiveness and harms of various operative and nonoperative treatments for rotator cuff tears is limited and inconclusive.
Agency for Healthcare Research and Quality.
Multiple therapies are available to treat rotator cuff tears.
This systematic review of 137 studies found evidence that patients with rotator cuff tears experienced improvements in function after undergoing any of several operative procedures or nonoperative therapy. Few complications were seen with the surgical procedures. Sparse comparative data precluded recommendations for a superior treatment approach.
The amount and strength of available evidence was low for many therapies.
Several therapies might benefit patients with rotator cuff tears and are associated with a reasonably low risk for harm, but we do not yet know the most beneficial therapy.
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