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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2021

01-12-2021 | Painful Arc | Research article

Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis

Authors: Umile Giuseppe Longo, Laura Risi Ambrogioni, Vincenzo Candela, Alessandra Berton, Arianna Carnevale, Emiliano Schena, Vincenzo Denaro

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

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Abstract

Background

This study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and 2 years of follow-up.

Methods

A comprehensive search of CENTRAL, MEDLINE, EMBASE, CINAHL, Google Scholar and reference lists of retrieved articles was performed since the inception of each database until August 2020. According to the Cochrane Handbook for Systematic Reviews of Interventions, two independent authors screened all suitable studies for the inclusion, extracted data and assessed risk of bias. Only randomised controlled trials comparing conservative and surgical management of full-thickness RC tear in adults were included. The primary outcome measure was the effectiveness of each treatment in terms of Constant-Murley score (CMS) and VAS pain score at different time points. The secondary outcome was the integrity of the repaired tendon evaluated on postoperative MRI at different time points. The GRADE guidelines were used to assess the critical appraisal status and quality of evidence.

Results

A total of six articles met the inclusion criteria. The average value of CMS score at 12 months of follow-up was 79.2 ± 13.7 in the surgery group and 72.7 ± 17.2 in the conservative group. The average value of CMS score at 24 months of follow-up was 80 ± 15 in the surgery group and 77 ± 15 in the conservative group. Results showed statistically significant differences between the CMS measured at one year of follow-up in favour of surgical RC repair compared with patients treated conservatively (P = 0.003). No significant differences were demonstrated in terms of CMS at 24 months of follow-up (P = 0.15). The mean of VAS pain score at 12 months of follow-up was 1.4 ± 1.6 in the surgery group and 2.4 ± 1.9 in the conservative group. Quantitative synthesis showed better results in favour of the surgical group in terms of VAS pain score one year after surgery (− 1.08, 95% CI − 1.58 to − 0.58; P < 0.001).

Conclusions

At a 2-year follow-up, shoulder function evaluated in terms of CMS was not significantly improved. Further high-quality level-I randomised controlled trials at longer term follow-up are needed to evaluate whether surgical and conservative treatment provide comparable long-term results.
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Metadata
Title
Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis
Authors
Umile Giuseppe Longo
Laura Risi Ambrogioni
Vincenzo Candela
Alessandra Berton
Arianna Carnevale
Emiliano Schena
Vincenzo Denaro
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Painful Arc
Published in
BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-03872-4

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