Rotator cuff repair vs. nonoperative treatment: a systematic review with meta-analysis

Fabrizio Brindisino; Mattia Salomon; Silvia Giagio; Chiara Pastore; Tiziano Innocenti

doi:10.1016/j.jse.2021.04.040

Rotator cuff repair vs. nonoperative treatment: a systematic review with meta-analysis

Fabrizio Brindisino^*
, Mattia Salomon
, Silvia Giagio
, Chiara Pastore
, Tiziano Innocenti

^*Corresponding author for this work

Health Economics and Health Technology Assessment

Research output: Contribution to Journal › Article › Academic › peer-review

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Abstract

Background: Rotator cuff (RC) tears have been widely studied as many treatment strategies have been recommended. However, optimal management for patients with RC tears is still unclear.

Purpose: The main aim of this systematic review was to analyze randomized controlled trials using meta-analysis to compare repair to conservative treatments for patients with any type of RC tear.

Methods: MEDLINE, Cochrane Library (CENTRAL database), PEDro, and Scopus databases were used. Two independent reviewers selected randomized controlled trials that compared surgical to conservative treatments for RC tear patients. The studies included were assessed using Cochrane Risk of Bias 2 tools, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the certainty of evidence and to summarize the study conclusions.

Results: Six trials were included. Pooled results showed improvement in function and pain perception in favor of the repair group at 6 months (mean difference 1.26, 95% CI –2.34, 4.85, P = .49; and –0.59, 95% CI –0.84, –0.33, P < .001, respectively), at 12 months (mean difference 5.25, 95% CI 1.55, 8.95, P = .005, for function; and –0.41, 95% CI –0.70, –0.12, P = .006, for pain) and at 24 months (mean difference 5.57, 95% CI 1.86, 9.29, P = .003, for function; and –0.92, 95% CI –1.31, –0.52, P < .001, for pain) in RC tear patients. However, these differences did not reach the minimum clinically important difference. The certainty of evidence ranged from low to moderate because of imprecision in the studies included.

Conclusions: Overall analysis showed that in patients with RC tear, repair compared with conservative treatment could result in increased pain reduction and functional improvement at 6, 12, and 24 months. Even if these effects were often statistically significant, their clinical relevance was limited. Moreover, the certainty of body of evidence ranged from low to moderate.

Original language	English
Pages (from-to)	2648-2659
Number of pages	12
Journal	Journal of Shoulder and Elbow Surgery
Volume	30
Issue number	11
Early online date	19 May 2021
DOIs	https://doi.org/10.1016/j.jse.2021.04.040
Publication status	Published - Nov 2021

Bibliographical note

Funding Information:
The authors thank Profs Mats C. Ranebo, MD, Frederik O. Lambers Heerspink, MD, Juha Kukkonen, MD, and Stefan Moosmayer, MD, for sharing the raw data of their manuscripts.

Publisher Copyright:
© 2021 Journal of Shoulder and Elbow Surgery Board of Trustees

Funding

The authors thank Profs Mats C. Ranebo, MD, Frederik O. Lambers Heerspink, MD, Juha Kukkonen, MD, and Stefan Moosmayer, MD, for sharing the raw data of their manuscripts.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Level II
meta-analysis
Meta-analysis
physical therapy modalities
rotator Cuff
shoulder Joint
Tissue Repair

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10.1016/j.jse.2021.04.040

Rotator cuff repair vs. nonoperative treatmentFinal published version, 1.37 MBLicence: Article 25fa Dutch Copyright Act

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Cite this

@article{2e1c2d41de4948ddabaa70ec1fa15303,

title = "Rotator cuff repair vs. nonoperative treatment: a systematic review with meta-analysis",

abstract = "Background: Rotator cuff (RC) tears have been widely studied as many treatment strategies have been recommended. However, optimal management for patients with RC tears is still unclear. Purpose: The main aim of this systematic review was to analyze randomized controlled trials using meta-analysis to compare repair to conservative treatments for patients with any type of RC tear. Methods: MEDLINE, Cochrane Library (CENTRAL database), PEDro, and Scopus databases were used. Two independent reviewers selected randomized controlled trials that compared surgical to conservative treatments for RC tear patients. The studies included were assessed using Cochrane Risk of Bias 2 tools, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the certainty of evidence and to summarize the study conclusions. Results: Six trials were included. Pooled results showed improvement in function and pain perception in favor of the repair group at 6 months (mean difference 1.26, 95\% CI –2.34, 4.85, P = .49; and –0.59, 95\% CI –0.84, –0.33, P < .001, respectively), at 12 months (mean difference 5.25, 95\% CI 1.55, 8.95, P = .005, for function; and –0.41, 95\% CI –0.70, –0.12, P = .006, for pain) and at 24 months (mean difference 5.57, 95\% CI 1.86, 9.29, P = .003, for function; and –0.92, 95\% CI –1.31, –0.52, P < .001, for pain) in RC tear patients. However, these differences did not reach the minimum clinically important difference. The certainty of evidence ranged from low to moderate because of imprecision in the studies included. Conclusions: Overall analysis showed that in patients with RC tear, repair compared with conservative treatment could result in increased pain reduction and functional improvement at 6, 12, and 24 months. Even if these effects were often statistically significant, their clinical relevance was limited. Moreover, the certainty of body of evidence ranged from low to moderate.",

keywords = "Level II, meta-analysis, Meta-analysis, physical therapy modalities, rotator Cuff, shoulder Joint, Tissue Repair",

author = "Fabrizio Brindisino and Mattia Salomon and Silvia Giagio and Chiara Pastore and Tiziano Innocenti",

note = "Funding Information: The authors thank Profs Mats C. Ranebo, MD, Frederik O. Lambers Heerspink, MD, Juha Kukkonen, MD, and Stefan Moosmayer, MD, for sharing the raw data of their manuscripts. Publisher Copyright: {\textcopyright} 2021 Journal of Shoulder and Elbow Surgery Board of Trustees",

year = "2021",

month = nov,

doi = "10.1016/j.jse.2021.04.040",

language = "English",

volume = "30",

pages = "2648--2659",

journal = "Journal of Shoulder and Elbow Surgery",

issn = "1058-2746",

publisher = "Elsevier Inc.",

number = "11",

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T1 - Rotator cuff repair vs. nonoperative treatment: a systematic review with meta-analysis

AU - Brindisino, Fabrizio

AU - Salomon, Mattia

AU - Giagio, Silvia

AU - Pastore, Chiara

AU - Innocenti, Tiziano

N1 - Funding Information: The authors thank Profs Mats C. Ranebo, MD, Frederik O. Lambers Heerspink, MD, Juha Kukkonen, MD, and Stefan Moosmayer, MD, for sharing the raw data of their manuscripts. Publisher Copyright: © 2021 Journal of Shoulder and Elbow Surgery Board of Trustees

PY - 2021/11

Y1 - 2021/11

N2 - Background: Rotator cuff (RC) tears have been widely studied as many treatment strategies have been recommended. However, optimal management for patients with RC tears is still unclear. Purpose: The main aim of this systematic review was to analyze randomized controlled trials using meta-analysis to compare repair to conservative treatments for patients with any type of RC tear. Methods: MEDLINE, Cochrane Library (CENTRAL database), PEDro, and Scopus databases were used. Two independent reviewers selected randomized controlled trials that compared surgical to conservative treatments for RC tear patients. The studies included were assessed using Cochrane Risk of Bias 2 tools, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the certainty of evidence and to summarize the study conclusions. Results: Six trials were included. Pooled results showed improvement in function and pain perception in favor of the repair group at 6 months (mean difference 1.26, 95% CI –2.34, 4.85, P = .49; and –0.59, 95% CI –0.84, –0.33, P < .001, respectively), at 12 months (mean difference 5.25, 95% CI 1.55, 8.95, P = .005, for function; and –0.41, 95% CI –0.70, –0.12, P = .006, for pain) and at 24 months (mean difference 5.57, 95% CI 1.86, 9.29, P = .003, for function; and –0.92, 95% CI –1.31, –0.52, P < .001, for pain) in RC tear patients. However, these differences did not reach the minimum clinically important difference. The certainty of evidence ranged from low to moderate because of imprecision in the studies included. Conclusions: Overall analysis showed that in patients with RC tear, repair compared with conservative treatment could result in increased pain reduction and functional improvement at 6, 12, and 24 months. Even if these effects were often statistically significant, their clinical relevance was limited. Moreover, the certainty of body of evidence ranged from low to moderate.

AB - Background: Rotator cuff (RC) tears have been widely studied as many treatment strategies have been recommended. However, optimal management for patients with RC tears is still unclear. Purpose: The main aim of this systematic review was to analyze randomized controlled trials using meta-analysis to compare repair to conservative treatments for patients with any type of RC tear. Methods: MEDLINE, Cochrane Library (CENTRAL database), PEDro, and Scopus databases were used. Two independent reviewers selected randomized controlled trials that compared surgical to conservative treatments for RC tear patients. The studies included were assessed using Cochrane Risk of Bias 2 tools, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the certainty of evidence and to summarize the study conclusions. Results: Six trials were included. Pooled results showed improvement in function and pain perception in favor of the repair group at 6 months (mean difference 1.26, 95% CI –2.34, 4.85, P = .49; and –0.59, 95% CI –0.84, –0.33, P < .001, respectively), at 12 months (mean difference 5.25, 95% CI 1.55, 8.95, P = .005, for function; and –0.41, 95% CI –0.70, –0.12, P = .006, for pain) and at 24 months (mean difference 5.57, 95% CI 1.86, 9.29, P = .003, for function; and –0.92, 95% CI –1.31, –0.52, P < .001, for pain) in RC tear patients. However, these differences did not reach the minimum clinically important difference. The certainty of evidence ranged from low to moderate because of imprecision in the studies included. Conclusions: Overall analysis showed that in patients with RC tear, repair compared with conservative treatment could result in increased pain reduction and functional improvement at 6, 12, and 24 months. Even if these effects were often statistically significant, their clinical relevance was limited. Moreover, the certainty of body of evidence ranged from low to moderate.

KW - Level II

KW - meta-analysis

KW - Meta-analysis

KW - physical therapy modalities

KW - rotator Cuff

KW - shoulder Joint

KW - Tissue Repair

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DO - 10.1016/j.jse.2021.04.040

M3 - Article

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AN - SCOPUS:85110452652

SN - 1058-2746

VL - 30

SP - 2648

EP - 2659

JO - Journal of Shoulder and Elbow Surgery

JF - Journal of Shoulder and Elbow Surgery

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ER -

Rotator cuff repair vs. nonoperative treatment: a systematic review with meta-analysis

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

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