Both operative and nonoperative approaches to the management of rotator cuff tears appear to result in substantial improvement, but a paucity of data from well-constructed studies means that no firm conclusions can be made about the best approach or the optimal overall management of the condition, according to authors of a meta-analysis of data from 137 studies.
The review showed that the benefits of being treated for a rotator cuff appear to outweigh the risks and that patients experience substantial improvement across all interventions.
Few differences of clinical importance were apparent in studies that compared interventions, and complications—most of which were not clinically important—occurred only rarely, reported Jennifer C. Seida of the University of Alberta, Edmonton, and her colleagues.
The authors searched 12 electronic databases, grey literature, trial registries, and reference lists to identify controlled and uncontrolled studies conducted between January 1990 and September 2009 that assessed the management of rotator cuff tears in adults.
All trials included in the meta-analysis were rated by a reviewer as having high risk of bias, and cohort and uncontrolled studies were, on average, rated as being of moderate quality.
No differences in reported functional outcomes were found in studies comparing open and mini-open repairs, mini-open and arthroscopic repairs, arthroscopic repairs with or without acromioplasty, and single- or double-row fixation.
However, earlier return to work occurred with mini-open compared with open repair; and with continuous passive motion plus physical therapy compared with physical therapy alone. Greater improvement in function was seen with open repairs compared with arthroscopic debridement, they said.
Still, they characterized the available evidence as limited and frequently low in quality across all interventions.
The lack of data on the best approach to management leaves physicians and patients uncertain about when nonoperative approaches should be aborted in favor of surgery, so future research should focus on comparing early with delayed surgical repair, they said.
“Investigators should use a streamlined approach in evaluating operative treatments, beginning with broad treatment questions before focusing on detailed procedures,” they wrote, adding that a comparative study design and appropriate confirmation of the diagnosis of rotator cuff are important.
Researchers should provide detailed reporting of study methodology and interventions to allow for appropriate interpretation of the results and for replication of treatments, the authors said.
The Agency for Healthcare Research and Quality funded this study. The authors had no disclosures.