These authors conducted a systematic review to assess evidence for improvements in outcome for all reported types of treatment modalities [physical therapy, tenotomy or tenodesis of the long head of the biceps, debridement, partial repair, subacromial spacer, deltoid flap, muscle transfer, rotator cuff advancement, graft interposition, superior capsular reconstruction (SCR), and reversed shoulder arthroplasty (RSA)] used for irreparable posterosuperior rotator cuff tears without glenohumeral osteoarthritis in articles published from January 2007 until January 2019, with minimum 2-year follow-up.
Sixty studies (2000 patients) were included with fair mean quality according to the Modified Coleman Methodology Score.
The employed definitions of ‘irreparable’ were mainly based on MRI criteria and were highly variable among studies.
The weighted mean preoperative to post-operative improvements in Constant Score are shown:
Treatments deltoid flap, muscle transfer, and debridement were the only treatments with available long-term (8–10-year) follow-up and showed similar improvements in Constant Score at this time point.
Comment: The authors point out that variability in patient characteristics, co-interventions, outcome reporting, and length of follow-up in studies on irreparable rotator cuff tears without osteoarthritis complicates sound comparison of treatments. It is of note that clinically important treatment effects were seen for all 11 different treatment modalities. The value of each of these treatments can be viewed as the benefit to the patient divided by the cost, time to recovery and risks of each treatment.
In that randomized control trials comparing different approaches to the management of irreparable cuff tears are unlikely to be carried out, we will need to rely on comparative data such as those presented in this paper to evaluate which treatments are optimal for which patients. These comparisons will be facilitated if clinical reports can fully characterize the patients, the shoulders, the treatments, and the outcome measures.
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