Multiple surgical treatment comparisons for irreparable rotator cuff tears: A network meta-analysis

Background. Massive rotator cuff tears are up to 40% and can progress to the stage of irreparable ones. Nowadays, there are many treatment options available for irreparable rotator cuff injuries, from conservative treatment and arthroscopic reconstructions to reverse shoulder arthroplasty. Currently, the comparative effectiveness of various treatment methods remains uncertain, and therefore there is no clear algorithm for choosing treatment tactics of such orthopedic shoulder pathologies. The aim of the study is to compare short-term treatment outcomes of patients with irreparable rotator cuff tears using arthroscopic partial rotator cuff repair, latissimus dorsi tendon transfer, pectoralis major tendon transfer and reverse shoulder arthroplasty. Methods. The study enrolled 75 patients who underwent the following types of surgical interventions: partial arthroscopic repair, posterior and anterior arthroscopically assisted latissimus dorsi tendon transfer, pectoralis major tendon transfer and reverse shoulder arthroplasty. Treatment results were assessed using measurements of the range of active movements in the shoulder joint, the ASES and Constant-Murley Score (CMS) questionnaires, the Visual Analog Scale (VAS), assessment of radiographs and MRI. The assessments were performed preoperatively and at 6 and 12 months after surgery. Results. In all groups, there was a statistically significant improvement by all indicators (p0.05). Clinical and functional results at the short-term follow-up after partial rotator cuff repair and various options of latissimus dorsi tendon transfer are largely comparable, while at the same time superior to the results of reverse shoulder arthroplasty and pectoralis major tendon transfer. Conclusions. The use of partial rotator cuff repair and musculotendinous transfers at the short-term follow-up gives comparable and better results in comparison with the use of reverse shoulder arthroplasty, which allows to consider “joint-preserving” interventions as an option in patients with massive irreparable rotator cuff tears.

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A Narrative Review of Rotator Cuff Tear Management: Surgery Versus Conservative Treatment

Altamimi,

Alkathami,

Al-Awn

et al. 2024

Cureus

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Rotator cuff tears are a prevalent musculoskeletal issue, particularly among middle-aged and elderly individuals, affecting shoulder stability and arm movement. These tears can arise from acute injuries or chronic wear and tear, leading to conditions ranging from tendinopathy to cuff tear arthropathy. The prevalence increases with age, with a significant portion of older adults affected, many of whom may be asymptomatic. This highlights the necessity for effective management strategies to improve patients' quality of life. The objective of this literature review is to evaluate the evidence on treatment options for rotator cuff injuries, particularly comparing the long-term results of surgical versus non-surgical interventions. While surgical treatments generally provide better functional outcomes and pain relief, nonsurgical options like physical therapy and corticosteroid injections can also be effective, especially for smaller tears. The choice of treatment depends on factors like the size of the tear, patient's age, activity level, and overall health. The review highlights the importance of personalized treatment approaches that consider both clinical and economic factors. Although surgical treatments may incur higher initial costs, they often offer superior long-term benefits, especially for younger patients or those with significant tears.

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Multiple surgical treatment comparisons for irreparable rotator cuff tears: A network meta-analysis

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Treatment of massive irreparable rotator cuff tears by different surgical technigues: comparative analysis of early outcomes

A Narrative Review of Rotator Cuff Tear Management: Surgery Versus Conservative Treatment

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