A scoping review and best evidence synthesis for treatment of partial-thickness rotator cuff tears
- PMID: 38103720
- DOI: 10.1016/j.jse.2023.10.027
A scoping review and best evidence synthesis for treatment of partial-thickness rotator cuff tears
Abstract
Background: Rotator cuff disorders include a broad spectrum of pathological conditions including partial-thickness and full-thickness tears. Studies have shown partial-thickness rotator cuff tear (PTRCT) prevalence to be twice that of full-thickness tears. In the working population, PTRCTs are one of the most common causes of shoulder pain and often result in occupational disability due to pain, stiffness, and loss of shoulder function. Treatment of PTRCTs remains controversial. The purpose of this study was to consolidate the existing high-quality evidence on best management approaches in treating PTRCTs using both nonoperative and operative approaches.
Methods: A scoping review with best evidence synthesis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE (OVID), EMBASE (OVID), Cochrane Library (Wiley), SCOPUS, Web of Science Core Collection, CINAHL Plus with Full Text (EBSCOhost), PubMed Central, and Science Direct were searched from 2000 to March 3, 2023. Level 1 studies, and systematic reviews and meta-analyses that included level 1 and 2 studies, were included.
Results: The search yielded 8276 articles. A total of 3930 articles were screened after removing 4346 duplicates. Application of inclusion criteria resulted in 662 articles that were selected for full-text review. Twenty-eight level 1 studies, 1 systematic review, 4 meta-analyses, and 1 network meta-analyses were included in the best evidence synthesis. Nonoperative strategies included injections (ie, platelet-rich plasma, corticosteroid, prolotherapy, sodium hyaluronate, anesthetic, and atelocollagen), exercise therapy, and physical agents. Operative interventions consisted of débridement, shaving of the tendon and footprint, transtendon repair, and traditional suture anchor repair techniques with and without tear completion. Both nonoperative and operative strategies demonstrated effectiveness at managing pain and functional outcome for PTRCTs. The evidence supports the effectiveness of surgical intervention in treating PTRCTs regardless of arthroscopic technique.
Conclusion: The results of this scoping review do not support superiority of operative over nonoperative management and suggest that both strategies can be effective at managing pain and functional outcome for PTRCTs. Surgery, however, is the most invasive and costly approach, with the highest risk of complications such as infection. Other variables such as patient expectation, treating practitioner bias, or preference may change which modalities are offered and in what sequence.
Keywords: Partial-thickness rotator cuff tear; best evidence synthesis; clinical outcomes; management; non-operative management; partial tear.
Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Similar articles
-
Improved outcomes with arthroscopic repair of partial-thickness rotator cuff tears: a systematic review.Knee Surg Sports Traumatol Arthrosc. 2018 Jan;26(1):113-124. doi: 10.1007/s00167-017-4564-0. Epub 2017 May 19. Knee Surg Sports Traumatol Arthrosc. 2018. PMID: 28526996 Review.
-
Multimedia article. The arthroscopic management of partial-thickness rotator cuff tears: a systematic review of the literature.Arthroscopy. 2011 Apr;27(4):568-80. doi: 10.1016/j.arthro.2010.09.019. Arthroscopy. 2011. PMID: 21296545 Review.
-
Minimum 10-Year Outcomes After Arthroscopic Repair of Partial-Thickness Supraspinatus Rotator Cuff Tears.Am J Sports Med. 2023 Jul;51(9):2404-2410. doi: 10.1177/03635465231176557. Epub 2023 Jun 12. Am J Sports Med. 2023. PMID: 37306068
-
When Should We Repair Partial-Thickness Rotator Cuff Tears? Outcome Comparison Between Immediate Surgical Repair Versus Delayed Repair After 6-Month Period of Nonsurgical Treatment.Am J Sports Med. 2018 Apr;46(5):1091-1096. doi: 10.1177/0363546518757425. Epub 2018 Mar 5. Am J Sports Med. 2018. PMID: 29505742 Clinical Trial.
-
Surgery for rotator cuff tears.Cochrane Database Syst Rev. 2019 Dec 9;12(12):CD013502. doi: 10.1002/14651858.CD013502. Cochrane Database Syst Rev. 2019. PMID: 31813166 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical