Clinical practice guidelines for the surgical management of rotator cuff tears in adults

Context: Rotator cuff tears are very common. In 2005, about 45 000 patients in France underwent surgery. Surgical techniques and indications have evolved over recent years with the development of arthroscopic procedures. The lack of visibility on current practice and a request by the French Ministry of Health to assess the fixation devices used in arthroscopic surgery prompted the drafting of these guidelines. Objectives: To produce guidelines on the indications and limitations of open surgery and arthroscopic surgery. Methods: A systematic review of the literature (2000-2007) was performed. It was submitted to a multidisciplinary working group of experts in the field (n = 12) who drafted an evidence report and clinical practice guidelines, which were amended in the light of comments from 36 peer reviewers. Main recommendations: (i) Medical treatment (oral medication, injections, physiotherapy) is always the first option in the management of degenerative tears of rotator cuff tendons. Surgery is a later option that depends on clinical and morphological factors, and patient characteristics. (ii) Surgery can be considered for the purpose of functional recovery in cases of a painful, weak or disabling shoulder refractory to medical treatment. (iii) Arthroscopy is indicated for non-reconstructive surgery or debridement, and for partial tear debridement or repair. (iv) Open surgery, mini-open surgery or arthroscopy can be used for a full-thickness tear accessible to direct repair by suture. (v) A humeral prosthesis or total reversed prosthesis is indicated for cuff tear arthropathy. (vi) The fixation devices used for bone reinsertion (anchors, screws, staples, and buttons) are indispensable for fully arthroscopic repair. No studies have determined the number of fixation devices to be used according to tear size. (C) 2010 Elsevier Masson SAS. All rights reserved.