Thursday, January 4, 2018

Rotator cuff tears - surgery or non-operative treatment?

Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis

These authors analyzed level I and II research comparing operative versus nonoperative management of full-thickness rotator cuff tears. The inclusion criteria were as follows: randomized controlled trial, full-thickness rotator cuff tear, and age 18 years or old. The exclusion criteria included any history of rotator cuff surgery and a follow-up period of less than 1 year.

After a review of 1013 articles only 3 qualified for inclusion representing 269 patients aged 59-65 years with 1-year follow-up.

While statistically significant differences favoring surgery were found in both Constant and VAS scores after 1 year, with mean differences of 5.64 (95% confidence interval, 2.06 to 9.21; P = .002) and −1.08 (95% confidence interval, −1.56 to −0.59; P < .0001), respectively, the differences were small and of questionable clinical significance.

The differences in both Constant and VAS scores were small and did not meet the minimal difference considered clinically significant. 

Comment: Cuff repair is more costly than non-operative management and the recovery period (down time) can be protracted. Better evidence is necessary to determine which patients with rotator cuff tear will realize substantial benefit from this procedure.