Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response.
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Author
Kovacevic, DavidSuriani, Robert J
Grawe, Brian M
Yian, Edward H
Gilotra, Mohit N
Hasan, S Ashfaq
Srikumaran, Umasuthan
Hasan, Samer S
Cuomo, Frances
Burks, Robert T
Green, Andrew G
Nottage, Wesley M
Theja, Sai
Kassam, Hafiz F
Saad, Maarouf A
Ramirez, Miguel A
Stanley, Rodney J
Williams, Matthew D
Nadarajah, Vidushan
Konja, Alexis C
Koh, Jason L
Rokito, Andrew S
Jobin, Charles M
Levine, William N
Schmidt, Christopher C
Keyword
Irreparable massive rotator cuff tearcomplications
failure rate
meta-analysis
patient-reported outcomes
reoperation
response to treatment
systematic review
Journal title
Journal of shoulder and elbow surgeryDate Published
2020-08-04Publication Volume
29Publication Issue
12Publication Begin page
2459Publication End page
2475
Metadata
Show full item recordAbstract
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.Citation
Kovacevic D, Suriani RJ Jr, Grawe BM, Yian EH, Gilotra MN, Hasan SA, Srikumaran U, Hasan SS, Cuomo F, Burks RT, Green AG, Nottage WM, Theja S, Kassam HF, Saad MA, Ramirez MA, Stanley RJ, Williams MD, Nadarajah V, Konja AC, Koh JL, Rokito AS, Jobin CM, Levine WN, Schmidt CC; American Shoulder and Elbow Surgeons Massive Cuff Evaluation and Research Initiative (ASES MERIT) Investigators. Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response. J Shoulder Elbow Surg. 2020 Dec;29(12):2459-2475. doi: 10.1016/j.jse.2020.07.030. Epub 2020 Aug 4. PMID: 32763381; PMCID: PMC7669555.DOI
10.1016/j.jse.2020.07.030ae974a485f413a2113503eed53cd6c53
10.1016/j.jse.2020.07.030
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- Creative Commons
Except where otherwise noted, this item's license is described as Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.