scholarly journals The Natural History of Full-Thickness Rotator Cuff Tears in Randomized Controlled Trials: A Systematic Review and Meta-analysis

2018 ◽  
Vol 47 (7) ◽  
pp. 1734-1743 ◽  
Author(s):  
Chetan Khatri ◽  
Imran Ahmed ◽  
Helen Parsons ◽  
Nicholas A. Smith ◽  
Thomas M. Lawrence ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Natural History ◽  
Treatment Response ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Controlled Trials ◽  
Full Thickness ◽  
Randomized Controlled ◽  
History Of

Background: Rotator cuff tears are the most common tendon injury in the adult population, resulting in substantial morbidity. The optimum management for these patients is not known. Purpose: To assess the overall treatment response to all interventions in full-thickness rotator cuff tears among patients enrolled in randomized clinical trials. Study Design: Systematic review and meta-analysis. Methods: Randomized controlled trials (RCTs) were identified from a systematic search of Medline, Embase, CINHAL, and the Cochrane Central Register of Controlled Trials. Patients were aged ≥18 years with a full-thickness rotator cuff tear. The primary outcome measure was change in Constant shoulder score from baseline to 52 weeks. A meta-analysis to assess treatment response was calculated via the standardized mean change in scores. Results: A total of 57 RCTs were included. The pooled standardized mean change as compared with baseline was 1.42 (95% CI, 0.80-2.04) at 3 months, 2.73 (95% CI, 1.06-4.40) at 6 months, and 3.18 (95% CI, 1.64-4.71) at 12 months. Graphic plots of treatment response demonstrated a sustained improvement in outcomes in nonoperative trial arms and all operative subgroup arms. Conclusion: Patients with full-thickness rotator cuff tears demonstrated a consistent pattern of improvement in Constant score with nonoperative and operative care. The natural history of patients with rotator cuff tears included in RCTs is to improve over time, whether treated operatively or nonoperatively.

Partial-Thickness Rotator Cuff Tears

2005 ◽  
Vol 33 (9) ◽  
pp. 1405-1417 ◽  
Author(s):  
Matthew J. Matava ◽  
Derek B. Purcell ◽  
Jonas R. Rudzki
Keyword(s):  
Rotator Cuff ◽  
Natural History ◽  
Diagnostic Techniques ◽  
Relative Accuracy ◽  
Diagnostic Methods ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Operative Repair ◽  
Partial Thickness ◽  
History Of

Partial-thickness tears of the rotator cuff have been diagnosed with increased frequency because of a heightened awareness of the condition by clinicians and improved diagnostic methods. Research into the causes, natural history, and optimal treatment of this condition lags behind that of full-thickness tears. However, despite the limitations in the existing literature, there has emerged a consensus among shoulder experts that partial-thickness rotator cuff tears should be aggressively treated in the active athlete because of the unfavorable natural history of these lesions and success of accepted surgical algorithms. This review will provide an overview of the theories regarding the origins of partial-thickness rotator cuff tears, discuss the relative accuracy of accepted diagnostic techniques, and summarize the indications and methods of operative repair with an emphasis on the results of various treatment approaches.

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