Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis

Background: Rotator cuff disease is the most common pathology of the shoulder, responsible for approximately 70% of clinic visits for shoulder pain. However, no consensus exists on the optimal treatment. The aim of this study was to analyze level I and II research comparing operative versus nonoperative management of full-thickness rotator cuff tears. Methods: A literature search was performed, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, to identify level I and II studies comparing operative versus nonoperative treatment of rotator cuff tears. Two independent researchers reviewed a total of 1013 articles. Three studies qualified for inclusion. These included 269 patients with 1-year follow-up. The mean age ranged from 59 to 65 years. Clinical outcome measures included the Constant score and visual analog scale (VAS) score for pain. Meta-analysis, using both fixed- and random-effects models, was performed on pooled results to determine overall significance. Results: Statistically significant differences favoring surgery were found in both Constant and VAS scores after 1 year, with mean differences of 5.64 (95% confidence interval, 2.06 to 9.21; P =.002) and -1.08 (95% confidence interval, -1.56 to -0.59; P <.0001), respectively. Conclusion: There was a statistically significant improvement in outcomes for patients managed operatively compared with those managed nonoperatively. The differences in both Constant and VAS scores were small and did not meet the minimal difference considered clinically significant. Larger studies with longer followup are required to determine whether clinical differences between these treatments become evident over time. (c) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.