The Natural History of Full-Thickness Rotator Cuff Tears in Randomized Controlled Trials: A Systematic Review and Meta-analysis

Abstract

44Background: Rotator cuff tears are the commonest tendon injury in the adult 45 population, resulting in substantial morbidity. The optimum management for these 46 patients is not known. The natural history of patients with rotator cuff tears included in RCTs is to improve 68 over time, whether treated operatively or non-operatively. 69 70What is known about the subject: Rotator cuff tears represent the commonest tendon 71 injury in the adult population, however the optimum management of these patients is 72 not known. In other chronic musculoskeletal conditions, it has been shown that there 73 is improvement in clinical outcome measures with all treatments over time. However, 74 it is not known if this is also true for rotator cuff tears. 75 76What this study adds to existing knowledge: This review found there is consistent 77 improvement in Constant score, irrespective of intervention given whether it is 78 operative, or non-operative treatments. Patient outcomes at 12 months are highly 79 predictive of outcomes at 24 months, suggesting that 12-month should be used as a 80 primary outcome time point for future randomised controlled trials in full-thickness 81 rotator cuff tears. 82 MAIN TEXT 83

A Randomized Controlled Trial of the Treatment of Rotator Cuff Tears with Bone Marrow Concentrate and Platelet Products Compared to Exercise Therapy: A Midterm Analysis

“…There is also evidence that surgical management does not result in superior outcomes compared to nonoperative treatment [14][15][16]. A recent meta-analysis of 57 randomized controlled trials found no difference between surgical outcomes compared to conservative management for treatment of full-thickness rotator cuff tears [17].…”

Meniscal Tear Outcome (METRO) review: a protocol for a systematic review summarising the clinical course and patient experiences of meniscal tears in the current literature

“…As in previously reported meta-analyses we will calculate a combined pooled SMC for each time point using a random effects model. 20 21 We will do this for the meniscectomy arm, meniscal repair arms and non-operative arms of studies. A simple correlation analysis (using Pearson’s correlation coefficient) on all SMCs between each pair of time points will be used to assess the relationship between intervals.…”

“…Prospective studies with well-defined entry criteria and follow-up points provide an excellent source of information on the natural history of a condition. 20 Researchers and clinicians need to better understand the natural history of meniscal tears to plan treatment decisions and future research.…”

“…Research into other musculoskeletal conditions has demonstrated that outcomes steadily improve over time regardless of treatment. 20 21 This could be due to the natural history of the condition or simply regression to the mean. The natural history of a condition is a crucial factor to consider during interpretation of outcomes from interventions of patients with meniscal tears.…”

Protocol for a randomised controlled trial of Subacromial spacer for Tears Affecting Rotator cuff Tendons: a Randomised, Efficient, Adaptive Clinical Trial in Surgery (START:REACTS)

“…[39][40][41][42][43] Based on our meta-analysis of outcomes for randomised trials, shoulder scores typically reach a plateau at 12 months after any intervention for a rotator cuff tear. 44 The 24-month scores do not give sufficient additional value to justify the increase in costs and delay in the trial result that would be required had 24 months been used as the primary outcome. collected at baseline and 3, 6 and months.…”