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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Suriani, Robert J
Grawe, Brian M
Yian, Edward H
Gilotra, Mohit N
Hasan, S Ashfaq
Hasan, Samer S
Burks, Robert T
Green, Andrew G
Nottage, Wesley M
Kassam, Hafiz F
Saad, Maarouf A
Ramirez, Miguel A
Stanley, Rodney J
Williams, Matthew D
Konja, Alexis C
Koh, Jason L
Rokito, Andrew S
Jobin, Charles M
Levine, William N
Schmidt, Christopher C
KeywordIrreparable massive rotator cuff tear
response to treatment
Journal titleJournal of shoulder and elbow surgery
Publication Begin page2459
Publication End page2475
MetadataShow full item record
AbstractBackground: 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.
CitationKovacevic 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.
The following license files are associated with this item:
- 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.
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