Schemitsch C, Chahal J, Vicente M, et al. Surgical repair versus conservative treatment and subacromial decompression for the treatment of rotator cuff tears: a meta-analysis of randomized trials. Bone Joint J. 2019 Sep;101-B(9):1100-1106. doi: 10.1302/0301-620X.101B9.BJJ-2018-1591.R1. (Systematic review)

AIMS: The purpose of this study was to compare the effectiveness of surgical repair to conservative treatment and subacromial decompression for the treatment of chronic/degenerative tears of the rotator cuff.

MATERIALS AND METHODS: PubMed, Cochrane database, and Medline were searched for randomized controlled trials published until March 2018. Included studies were assessed for methodological quality, and data were extracted for statistical analysis. The systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS: Six studies were included. Surgical repair resulted in a statistically significantly better Constant-Murley Score (CMS) at one year compared with conservative treatment (mean difference 6.15; p = 0.002) and subacromial decompression alone (mean difference 5.81; p = 0.0004). In the conservatively treated group, 11.9% of patients eventually crossed over to surgical repair.

CONCLUSION: The results of this review show that surgical repair results in significantly improved outcomes when compared with either conservative treatment or subacromial decompression alone for degenerative rotator cuff tears in older patients. However, the magnitude of the difference in outcomes between surgery and conservative treatment may be small and the 'success rate' of conservative treatment may be high, allowing surgeons to be judicious in choosing those patients who are most likely to benefit from surgery. Cite this article: Bone Joint J 2019;101-B:1100-1106.

Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Comments from MORE raters

Rehab Clinician (OT/PT) rater

This meta-analysis of RCT's considering management of none traumatic rotator cuff tears in the the older population found a small difference in favour of surgical repair in this group. However, the difference was small and questionably clinically significant. The 'success rate' of conservative management "may be high". The authors suggest that there is basis for patients in this group to be managed conservatively initially with only those failing conservative management being offered a surgical option.
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