Purpose
To compare the different interventions described in the literature for the surgical
treatment of small and medium complete rotator cuff tears.
Methods
A systematic review of randomized controlled trials of small-medium, full-thickness
rotator cuff tears published since 2000 was performed. Clinical characteristics, re-tear
rates, range of motion (ROM), and patient-reported outcomes (PRO) data were collected.
Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects
model. Interventions were ranked for each domain (re-tear risk, pain, ROM, and PROs)
via surface under the cumulative ranking curves.
Results
A total of 18 studies comprising 2046 shoulders (47% females, mean age 61 ± 3 years,
mean follow-up 21 ± 5 months) were included. Interventions that ranked highest for
minimizing re-tear risk included arthroscopic single-row repair (A+SR) or double-row
repair (A+DR) with or without platelet-rich plasma (PRP). Open repair and A+SR repair
with acromioplasty (ACP) ranked highest for pain relief. Interventions that ranked
highest for ROM improvement included open repair, PT, and A+DR with or without ACP.
Interventions that ranked highest for PROs included arthroscopic footprint microfracture
with or without SR, open repair, and A+SR with or without ACP.
Conclusions
Based on a network meta-analysis of level 1 studies, arthroscopic rotator cuff repair
with a SR or DR construct demonstrates similar retear rates, PROs, and clinical outcomes.
The highest-ranking treatment for minimizing retears was arthroscopic repair with
DR constructs and PRP augmentation, although open repair and arthroscopic SR remain
reliable options with excellent clinical outcomes. Addition of PRP to DR constructs
trended toward a 56% decreased risk of retear as compared to DR repair alone. Although
no single treatment emerged superior, several interventions offered excellent clinical
improvements in pain, ROM, and PROs that exceeded minimal clinically important difference
thresholds.
Level of evidence
I, systematic review and meta-analysis of level I studies.
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Article info
Publication history
Published online: March 21, 2022
Accepted:
March 3,
2022
Received:
September 23,
2021
Footnotes
The authors report the following potential conflicts of interest or sources of funding: D.N.B. reports editorial or governing board membership for Clinical Orthopaedics and Related Research and the Journal of Orthopaedic Experience & Innovation; and employment at Institute For Strategy and Competitiveness at Harvard Business School. E.J.B. reports stock in Amgen, Co., Johnson & Johnson, and Pfizer, Inc. K.C.P. reports stock or stock options in Johnson & Johnson. B.F. reports grants from Arthrex, Inc., Smith & Nephew, and Stryker; royalties from Elsevier; consulting fees from Smith & Nephew; board membership for American Orthopaedic Society for Sports Medicine and Video Journal of Sports Medicine; stock or stock options for I-BrainTech, Jace Medical, and Sparta Biopharma; and receives financial or material support from Elsevier. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 Published by Elsevier on behalf of the Arthroscopy Association of North America
