Low level of evidence for all treatment modalities for irreparable posterosuperior rotator cuff tears

Abstract

Purpose This systematic review assesses 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 lap, muscle transfer, rotator cuf advancement, graft interposition, superior capsular reconstruction (SCR), and reversed shoulder arthroplasty (RSA)] used for irreparable posterosuperior rotator cuf tears without glenohumeral osteoarthritis. The primary aim was to be able to inform patients about expectations of the amount of clinical improvement after these treatments. Methods A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane databases for studies on irreparable posterosuperior rotator cuf lesions without glenohumeral osteoarthritis, published from January 2007 until January 2019, with minimum 2-year follow-up. Studies with pre-operative and/or intra-operative determination of cuf tear irreparability were included. We deined the non-adjusted Constant Score as the primary outcome. Results Sixty studies (2000 patients) were included with a fair mean quality score, according to the Modiied Coleman Methodology Score. The employed deinitions of 'irreparable' were mainly based on MRI criteria and were highly variable among studies. The smallest weighted mean preoperative to post-operative improvements in Constant Score were reported for biceps tenotomy/tenodesis (10.7 points) and physical therapy (13.0). These were followed by debridement (21.8) and muscle transfer (27.8), whereas the largest increases were reported for partial repair (32.0), subacromial spacer (32.5), rotator cuf advancement (33.2), RSA (34.4), graft reconstruction (35.0), deltoid lap (39.8), and SCR (47.4). Treatment using deltoid lap showed highest mean weighted improvement in Constant Score among studies with available medium-term (4-5-year) follow-up. Treatments deltoid lap, 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. ConclusionThe variability in patient characteristics, co-interventions, outcome reporting, and length of follow-up in studies on irreparable rotator cuf tears without osteoarthritis complicates sound comparison of treatments. Clinically important treatment efects were seen for all 11 diferent treatment modalities. Level of evidence IV.

Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation

“…32 Originally proposed by Mihata et al, 38 continuous evolution of arthroscopic techniques has led to the use of different materials for SCR, including allografts, autografts, xenografts, or synthetic patches. 12,16,19,28,29,32,49 Subsequent preliminary clinical trials yielded promising satisfactory results 7,14,35-39 ; however, the optimal choice of graft type remains a matter of debate among shoulder surgeons because of donor site morbidity, time of surgery, cost-effectiveness, and graft failures with subsequent functional impairment. 9,14,17,21,31…”

Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction

“…3,4,9,24,34,46 In massive rotator cuff tears, repair of these structures often remains challenging due to atrophy, retraction, and fatty infiltration of the remaining rotator cuff. 5,22,27 Although arthroplasty and muscle tendon transfers have been described, clinical outcomes have been mixed and significant complications have been reported. 16,17 Thus, superior capsular reconstruction (SCR) has emerged as an increasingly popular procedure with initial promising biomechanical results in restoring glenohumeral kinematics.…”

The results of using a tendon autograft as a new rotator cable for patients with a massive rotator cuff tear: a technical note and comparative outcome analysis

“…Treating MRCTs remains a significant challenge for the clinicians. Several surgical options are available for [28]. Joint preserving procedures are preferably used in young patients; in the older population, reversed shoulder arthroplasty or maybe the subacromial balloon spacer might be indicated.…”