Nonoperative and operative treatments for rotator cuff tears

January 01, 0001

Nonoperative and operative treatments for rotator cuff tears

Many approaches exist for managing rotator cuff tears. These Canadian authors conducted a systematic review to compare the benefits and harms of nonoperative and operative interventions on clinically important outcomes in adults with rotator cuff tears. They selected controlled and uncontrolled studies that assessed nonoperative or operative treatments or postoperative rehabilitation for adults with confirmed rotator cuff tears. Studies were assessed in duplicate.

They found: "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."

The authors concluded: "Evidence on the comparative effectiveness and harms of various operative and nonoperative treatments for rotator cuff tears is limited and inconclusive."

There you have the state of the evidence on this question, which indicates need for well-designed clinical trials.

For the full abstract, click here.

Annals of Internal Medicine 153(4):246-255, 17 August 2010
© 2010 to the American College of Physicians
Nonoperative and Operative Treatments for Rotator Cuff Tears. Jennifer C. Seida, Claire LeBlanc, Janine R. Schouten, et al. Correspondence to Dr. Seida: [email protected]

Category: M. Musculoskeletal. Keywords: rotator cuff tears, surgery, functional outcomes, acromioplasy, fixation, physical therapy, systematic review, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 31 August 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.