Systematic review: nonoperative and operative treatments for rotator cuff tears.
BACKGROUND
Many approaches exist for managing rotator cuff tears.


OBJECTIVE
To compare the benefits and harms of nonoperative and operative interventions on clinically important outcomes in adults with rotator cuff tears.


METHODS
12 electronic databases (1990 to September 2009), gray literature, trial registries, and reference lists were searched.


METHODS
Controlled and uncontrolled studies that assessed nonoperative or operative treatments or postoperative rehabilitation for adults with confirmed rotator cuff tears were included. Operative studies in English-language publications and nonoperative and postoperative rehabilitation studies in English, French, or German were considered. Studies were assessed in duplicate.


METHODS
2 reviewers assessed risk for bias by using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. One reviewer rated the evidence by using a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Data were extracted by one reviewer and verified by another.


RESULTS
137 studies met eligibility criteria. All trials had high risk for bias. Cohort and uncontrolled studies were of moderate quality. Reported functional outcomes did not differ between open versus mini-open repair, mini-open versus arthroscopic repair, arthroscopic repair with versus without acromioplasty, or single-row versus double-row fixation. Earlier return to work was reported for mini-open repair versus open repair and for continuous passive motion with physical therapy versus physical therapy alone. Open repairs showed greater improvement in function than did arthroscopic debridement. Complication rates were low across all interventions.


CONCLUSIONS
Limited evidence, which was often of low quality, precluded conclusions for most comparisons. Language restrictions may have excluded some relevant studies, and selective outcome reporting may have introduced bias.


CONCLUSIONS
Evidence on the comparative effectiveness and harms of various operative and nonoperative treatments for rotator cuff tears is limited and inconclusive.


BACKGROUND
Agency for Healthcare Research and Quality.
Seida
Jennifer C
JC
Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada. jennifer.seida@ualberta.ca
LeBlanc
Claire
C
Schouten
Janine R
JR
Mousavi
Shima S
SS
Hartling
Lisa
L
Vandermeer
Ben
B
Tjosvold
Lisa
L
Sheps
David M
DM
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D019637:Orthopedic Procedures / Q000379:methods; D026741:Physical Therapy Modalities; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D012107:Research Design / Q000592:standards; D017006:Rotator Cuff / Q000502:physiology / Q000601:surgery; D000070636:Rotator Cuff Injuries; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D055675:Viscosupplements / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000601:surgery / Q000628:therapy
D000893:Anti-Inflammatory Agents; D013256:Steroids; D055675:Viscosupplements; D003907:Dexamethasone; D006820:Hyaluronic Acid