Rotator cuff repair versus nonoperative treatment: a systematic review with metaanalysis
These authors conducted a systematic review to analyze randomized controlled trials (RCTs) comparing rotator cuff repair to non-operative treatment for patients with any type of RC tear.
Six RCTs met the inclusion criteria.
At 6 months, pooled results showed improvement in favor of the repair group with respect to the Constant score (mean difference 1.26 [CI 95% -2.34 to 4.85, p=0.49) and pain perception (0.59 [95% CI -0.84 to -0.33, p< 0.00001).
At 12 months pooled results showed improvement in favor of the repair group with respect to the Constant score (mean difference 5.25 [CI 22 95% 1.55 to 8.95, p= 0.005) and pain perception(mean difference -0.41 [CI 95% -0.70 to -0.12, p=0.006]).
At 24 months pooled results showed improvement in favor of the repair group with respect to the Constant score (mean difference 5.57 [CI 95% 1.86 to 9.29 p= 0.003] and for pain perception (mean difference -0.92 [CI 95% -1.31 to -0.52 p<0.00001]).
However, these differences did not reach the minimum clinically important difference for the Constant score (10.4) or the VAS pain score (2.17).
The certainty of evidence ranged from low to moderate due to imprecision in the studies included. The authors question whether these statistically significant effects are clinically significant.
The authors concluded that this systematic review with meta-analysis on repair versus conservative treatment for patients with rotator cuff tears showed statistically, but not clinically, meaningful difference between repair and conservative treatment in terms of improvement in pain and Constant score.
Comment: These findings can be compared to the 2019 Evidence Based Practice Guidelines from the American Academy of Orthpaedic Surgeons
