David Kovacevic1, Robert J Suriani2, Brian M Grawe3, Edward H Yian4, Mohit N Gilotra5, S Ashfaq Hasan5, Umasuthan Srikumaran6, Samer S Hasan7, Frances Cuomo8, Robert T Burks9, Andrew G Green10, Wesley M Nottage11, Sai Theja2, Hafiz F Kassam2, Maarouf A Saad2, Miguel A Ramirez12, Rodney J Stanley13, Matthew D Williams14, Vidushan Nadarajah5, Alexis C Konja2, Jason L Koh15, Andrew S Rokito16, Charles M Jobin2, William N Levine2, Christopher C Schmidt17. 1. Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA. Electronic address: dk2806@cumc.columbia.edu. 2. Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA. 3. Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA. 4. Kaiser Permanente Southern California, Anaheim, CA, USA. 5. Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA. 6. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA. 7. MercyHealth/Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH, USA. 8. Department of Orthopaedic Surgery, Montefiore Medical Center, New York, NY, USA. 9. Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA. 10. Department of Orthopaedic Surgery, Warren Alpert Medical School at Brown University/Rhode Island Hospital, Providence, RI, USA. 11. The Sports Clinic Orthopaedic Medical Associates, Laguna Hills, CA, USA. 12. OSF Saint Francis Medical Center, Peoria, IL, USA. 13. OrthoCarolina, Mooresville, NC, USA. 14. Louisiana Orthopaedic Specialists, Lafayette, LA, USA. 15. NorthShore Orthopaedic Institute, NorthShore University Health System, Evanston, IL, USA. 16. Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA. 17. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Abstract
BACKGROUND: There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic review and meta-analysis was to (1) compare patient-reported outcome scores, (2) define failure and reoperation rates, and (3) quantify the magnitude of patient response across treatment strategies. METHODS: The MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus databases were searched for studies including physical therapy and operative treatment of massive rotator cuff tears. The criteria of the Methodological Index for Non-randomized Studies were used to assess study quality. Primary outcome measures were patient-reported outcome scores as well as failure, complication, and reoperation rates. To quantify patient response to treatment, we compared changes in the Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score with previously reported minimal clinically important difference (MCID) thresholds. RESULTS: No level I or II studies that met the inclusion and exclusion criteria were found. Physical therapy was associated with a 30% failure rate among the included patients, and another 30% went on to undergo surgery. Partial repair was associated with a 45% retear rate and 10% reoperation rate. Only graft interposition was associated with a weighted average change that exceeded the MCID for both the Constant-Murley score and ASES score. Latissimus tendon transfer techniques using humeral bone tunnel fixation were associated with a 77% failure rate. Superior capsular reconstruction with fascia lata autograft was associated with a weighted average change that exceeded the MCID for the ASES score. Reverse arthroplasty was associated with a 10% prosthesis failure rate and 8% reoperation rate. CONCLUSION: There is a lack of high-quality comparative studies to guide treatment recommendations. Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate.
BACKGROUND: There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic review and meta-analysis was to (1) compare patient-reported outcome scores, (2) define failure and reoperation rates, and (3) quantify the magnitude of patient response across treatment strategies. METHODS: The MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus databases were searched for studies including physical therapy and operative treatment of massive rotator cuff tears. The criteria of the Methodological Index for Non-randomized Studies were used to assess study quality. Primary outcome measures were patient-reported outcome scores as well as failure, complication, and reoperation rates. To quantify patient response to treatment, we compared changes in the Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score with previously reported minimal clinically important difference (MCID) thresholds. RESULTS: No level I or II studies that met the inclusion and exclusion criteria were found. Physical therapy was associated with a 30% failure rate among the included patients, and another 30% went on to undergo surgery. Partial repair was associated with a 45% retear rate and 10% reoperation rate. Only graft interposition was associated with a weighted average change that exceeded the MCID for both the Constant-Murley score and ASES score. Latissimus tendon transfer techniques using humeral bone tunnel fixation were associated with a 77% failure rate. Superior capsular reconstruction with fascia lata autograft was associated with a weighted average change that exceeded the MCID for the ASES score. Reverse arthroplasty was associated with a 10% prosthesis failure rate and 8% reoperation rate. CONCLUSION: There is a lack of high-quality comparative studies to guide treatment recommendations. Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate.
Authors: Joel J Gagnier; Chris Robbins; Asheesh Bedi; James E Carpenter; Bruce S Miller Journal: J Shoulder Elbow Surg Date: 2018-01-04 Impact factor: 3.019
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