Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis

Piper, Christine C.; Hughes, Alice J.; Ma, Yan; Wang, Haijun; Neviaser, Andrew S.

doi:10.1016/j.jse.2017.09.032

Cited by 112 publications

(74 citation statements)

References 25 publications

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“…Few studies comparing synthetic patch to other treatment methods for symptomatic rotator cuff tear have been reported. These generally involve similar patient numbers with massive RoCTs to the current study (ranging from 21 to 60 patients with patch repair), and include a comparison of the synthetic patch with no patch [53]; a comparison with biological collagen patch as well as standard repair group [54]; a comparison of patch plus bone marrow and arthroscopic cuff repair [55]; and patch Vs partial repair [56]. The synthetic patch demonstrated a lower retear rate, and…”

Section: Discussionmentioning

confidence: 99%

The use of a synthetic shoulder patch for large and massive rotator cuff tears – a feasibility study

Cowling

Hackney

Dube

et al. 2020

BMC Musculoskelet Disord

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Background: The aim of this study was to explore the feasibility of using a non-absorbable biocompatible polyester patch to augment open repair of massive rotator cuff tears (Patch group) and compare outcomes with other treatment options (Non-patch group). Methods: Participants referred to orthopaedic clinics for rotator cuff surgery were recruited. Choice of intervention (Patch or Non-patch) was based on patient preference and intra-operative findings. Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), and Constant score were completed at baseline and 6 months. Shoulder MRI was performed at baseline and 6 months to assess fat fraction and Goutallier classification pre-and post-treatment. Feasibility outcomes (including retention, consent and missing data) were assessed. Results: Sixty-eight participants (29 in the Patch group, 39 in Non-patch group) were included (mean age 65.3 years). Conversion to consent (92.6%), missing data (0% at baseline), and attrition rate (16%) were deemed successful feasibility endpoints. There was significant improvement in the Patch group compared to Non-patch at 6 months in OSS (difference in medians 9.76 (95% CI 2.25, 17.29) and SPADI: 22.97 (95% CI 3.02, 42.92), with no substantive differences in Constant score. The patch group had a higher proportion of participants improving greater than MCID for OSS (78% vs 62%) and SPADI (63% vs 50%) respectively. Analysis of the 48 paired MRIs demonstrated a slight increase in the fat fraction for supraspinatus (53 to 55%), and infraspinatus (26 to 29%) at 6 months. These differences were similar and in the same direction when the participants were analysed by treatment group. The Goutallier score remained the same or worsened one grade in both groups equally. Conclusions: This study indicates that a definitive clinical trial investigating the use of a non-absorbable patch to augment repair of massive rotator cuff tears is feasible. In such patients, the patch has the potential to improve shoulder symptoms at 6 months. Trial registration: ISRCTN, ISRCTN79844053, Registered 15th October 2014 (retrospectively registered).

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Section: Discussionmentioning

confidence: 99%

The use of a synthetic shoulder patch for large and massive rotator cuff tears – a feasibility study

Cowling

Hackney

Dube

et al. 2020

BMC Musculoskelet Disord

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“…Both studies have included results from the same 3 studies (Moosmayer, Kukkonen and Lambers-Heerspink). Piper et al 227 found a significant between group difference of 5.6 in Constant score (95% CI 2.06-9.21; P=0.002) in favour of repair. Ryösä et al also found a between-group difference of 5.6, but with wider confidence intervals (95% CI -0.41 to 11.62; P=0.068).…”

Section: Acromioplasty Without Cuff Repairmentioning

confidence: 95%

“…Attempts to summarize results of existing RCTs with 12-month results have been made in 2 recent systematic reviews and meta-analyses 227,240 . Both studies have included results from the same 3 studies (Moosmayer, Kukkonen and Lambers-Heerspink).…”

Section: Acromioplasty Without Cuff Repairmentioning

confidence: 99%

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

Ranebo

2020

Linköping University Medical Dissertations

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“…This condition with increasing incidence in the active population explain the critical socioeconomic burden that should be considered [3,4]. Several studies are currently ongoing to evaluate the potential superiority of conservative treatment over a surgical approach [7][8][9][10][11][12]. Although much of the healthcare expenditure is due to intervention and hospitalization, the economic burden of the rehabilitation period may be underestimated [1].…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis

Longo

Berton

Ambrogioni

et al. 2020

IJERPH

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Background: The objective of the present study was to compare the efficacy between supervised and unsupervised rehabilitation after rotator-cuff (RC) repair in terms of clinical outcomes, visual-analog-scale (VAS) score, range of motion (ROM), and risk of retear. Material: a comprehensive search of Pubmed, CINAHL, Cochrane, EMBASE, Ovid, and Google Scholar databases through a combination of the following keywords with logical Boolean operators: “informed”, “uninformed”, “unsupervised”, “supervised”, “rehabilitation”, “physical therapy”, “physical therapies”, “postoperative period”, “physical-therapy techniques”, “physical-therapy technique”, “exercise”, “exercise therapy”, “rotator cuff”, “rotator-cuff tear”, and “rotator-cuff repair”. For each article included in the study, the following data were extracted: authors, year, study design, sample size and demographic features, RC tear characteristics, clinical outcomes, ROM, VAS score, retear rate, and time of follow-up. Meta-analysis was performed in terms of VAS score. Results: Four randomized control trials with 132 patients were included. One study demonstrated significant improvement in VAS, active ROM, and the activity of the muscle’s motor units at stop and during maximal effort in supervised patients. Another one showed lower retear rates in the supervised group. The remaining two randomized controlled trials did not reveal any significant differences between supervised and unsupervised rehabilitation in terms of clinical outcomes. Moreover, higher costs were described for supervised rehabilitation. The VAS was not significantly different in the two groups (9.9 compared with 8.25, p = 0.23). Conclusions: although several publications address the problem of RC lacerations, there is a paucity of evidence in the literature regarding the effectiveness of supervised and unsupervised rehabilitation protocols. This systematic review and meta-analysis showed no significant differences between the two types of rehabilitation in terms of VAS scores, while outlining the pros and cons of each protocol.

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Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis

Cited by 112 publications

References 25 publications

The use of a synthetic shoulder patch for large and massive rotator cuff tears – a feasibility study

The use of a synthetic shoulder patch for large and massive rotator cuff tears – a feasibility study

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis

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