EXERCISE THERAPY IN THE NON-OPERATIVE TREATMENT OF FULL-THICKNESS ROTATOR CUFF TEARS: A SYSTEMATIC REVIEW

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.

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Effects of 12 Weeks of Progressive Early Active Exercise Therapy After Surgical Rotator Cuff Repair: 12 Weeks and 1-Year Results From the CUT-N-MOVE Randomized Controlled Trial

The American Journal of Sports Medicine ◽

10.1177/0363546520983823 ◽

2021 ◽

Vol 49 (2) ◽

pp. 321-331

Author(s):

Birgitte Hougs Kjær ◽

S. Peter Magnusson ◽

Marius Henriksen ◽

Susan Warming ◽

Eleanor Boyle ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Rotator Cuff ◽

Usual Care ◽

Exercise Therapy ◽

Controlled Trial ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Randomized Controlled ◽

Secondary Outcomes

Background: Traumatic full-thickness rotator cuff tears are typically managed surgically, followed by rehabilitation, but the load progression to reach an optimal clinical outcome during postoperative rehabilitation is unknown. Purpose: To evaluate whether there was a superior effect of 12 weeks of progressive active exercise therapy on shoulder function, pain, and quality of life compared with usual care. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients with surgically repaired traumatic full-thickness rotator cuff tears were recruited from 2 orthopaedic departments and randomized to progressive active exercise therapy (PR) or limited passive exercise therapy (UC [usual care]). The primary outcome was the change in the Western Ontario Rotator Cuff Index (WORC) score between groups from before surgery to 12 weeks after surgery. Secondary outcomes included changes in the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, pain, range of motion, and strength. Adverse events were registered during the intervention period. Results: A total of 82 patients were randomized to the PR (n = 41) or UC (n = 41) group. All 82 patients (100%) participated in the 12-week assessment and 79 in the 1-year follow-up. At 12 weeks, there was no significant difference between the groups in the change in the WORC score from baseline adjusted for age, sex, and center (physical symptoms: P = .834; sports and recreation: P = .723; work: P = .541; lifestyle: P = .508; emotions: P = .568). Additionally, there was no between-group difference for the secondary outcomes including the WORC score at 1 year and the DASH score, pain, range of motion, and strength at 12 weeks and 1 year. Both groups showed significant improvements over time in all outcomes. In total, there were 13 retears (16%) at 1-year follow-up: 6 in the PR group and 7 in the UC group. Conclusion: PR did not result in superior patient-reported and objective outcomes compared with UC at either short- or long-term follow-up (12 weeks and 1 year). Registration: NCT02969135 ( ClinicalTrials.gov identifier)

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The Critical Shoulder Angle Shows a Reciprocal Change in Magnitude When Evaluating Symptomatic Full-Thickness Rotator Cuff Tears Versus Primary Glenohumeral Osteoarthritis as Compared With Control Subjects: A Systematic Review and Meta-analysis

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2019.09.024 ◽

2020 ◽

Vol 36 (2) ◽

pp. 566-575 ◽

Cited By ~ 2

Author(s):

Geoffrey C.S. Smith ◽

Victor Liu ◽

Patrick H. Lam

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Meta Analysis ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Critical Shoulder Angle ◽

Control Subjects ◽

Glenohumeral Osteoarthritis ◽

Shoulder Angle ◽

Reciprocal Change

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Is acromioplasty necessary in the setting of full-thickness rotator cuff tears? A systematic review

Journal of Orthopaedics and Traumatology ◽

10.1007/s10195-015-0353-z ◽

2015 ◽

Vol 16 (3) ◽

pp. 167-174 ◽

Cited By ~ 25

Author(s):

Filippo Familiari ◽

Alan Gonzalez-Zapata ◽

Bruno Iannò ◽

Olimpio Galasso ◽

Giorgio Gasparini ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Tears ◽

Full Thickness

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A Randomized Controlled Trial of the Treatment of Rotator Cuff Tears with Bone Marrow Concentrate and Platelet Products Compared to Exercise Therapy: A Midterm Analysis

Stem Cells International ◽

10.1155/2020/5962354 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Christopher Centeno ◽

Zachary Fausel ◽

Ian Stemper ◽

Ugochi Azuike ◽

Ehren Dodson

Keyword(s):

Bone Marrow ◽

Rotator Cuff ◽

Exercise Therapy ◽

Controlled Trial ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Ultrasound Guided ◽

Percutaneous Injection ◽

Bone Marrow Concentrate ◽

Patient Reported

Injectable regenerative therapies such as bone marrow concentrate (BMC) and platelet-rich plasma (PRP) may represent a safe alternative in the treatment of rotator cuff tears. This is a midterm review of a randomized, crossover trial comparing autologous BMC and platelet product injections versus exercise therapy in the treatment of partial and full-thickness supraspinatus tears. Patients enrolled into the study were between 18 and 65 years of age presenting to an outpatient orthopedic clinic with partial to full thickness, nonretracted supraspinatus tendon tears. Enrolled patients were randomized to either ultrasound-guided autologous BMC with PRP and platelet lysate (PL) percutaneous injection treatment or exercise therapy. Patients could cross over to BMC treatment after at least 3 months of exercise therapy. Patients completed the Disability of the Arm, Shoulder and Hand (DASH) scores as the primary outcome measure. Secondary outcomes included the numeric pain scale (NPS), a modified Single Assessment Numeric Evaluation (SANE), and a blinded MRI review. At this midterm review, results from 25 enrolled patients who have reached at least 12-month follow-up are presented. No serious adverse events were reported. Significant differences were seen in patient reported outcomes for the BMC treatment compared to exercise therapy at 3 and 6 months for pain, and for function and reported improvement (SANE) at 3 months (p<.05). Patients reported a mean 89% improvement at 24 months, with sustained functional gains and pain reduction. MRI review showed a size decrease of most tears post-BMC treatment. These findings suggest that ultrasound-guided BMC and platelet product injections are a safe and useful alternative to conservative exercise therapy of torn, nonretracted supraspinatus tendons. This trial is registered with NCT01788683.

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