AHRQ study finds rotator cuff injuries treatable, but best method uncertain

Many treatment options are available for patients with rotator cuff tears, but it is uncertain whether patients benefit more from operative or nonoperative interventions, according to an Agency for Healthcare Research and Quality report.

“Rotator cuff surgery is a viable option for many patients, but, as with any surgery, it is not for everybody,” Carolyn M. Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ) stated in a press release. “This report has good news: most interventions work, and each patient should talk to his or her doctor about which to option to pursue.”

Jennifer C. Seida, MPH, and colleagues at the University of Alberta Evidence-based Practice Center prepared the report, which was published in Annals of Internal Medicine.

Functional outcomes

The investigators performed a systematic review that included 137 studies which assessed nonoperative or operative treatments or postoperative rehabilitation for adults with rotator cuff tears. They aimed to compare the benefits and drawbacks of operative and nonoperative treatments, according to the study abstract.

Overall, patients experienced improvements in function across all interventions, with few reported complications, the researchers noted.

“Reported functional outcomes did not differ between open vs. mini-open repair, mini-open vs. arthroscopic repairs, arthroscopic repairs with vs. without acromioplasty, or single-row vs. double-row fixation,” according to the abstract.

Sparse data

While the study was not without limitations — limited and low-quality evidence and language restrictions being among those reported by the authors — it differs from previously published studies “because it assesses the full range of nonoperative and operative treatment options, includes a broad range of study designs, and considers only studies which confirmed the presence of rotator cuff tears,” the authors wrote.

They concluded that, due to the sparse availability of data, a firm conclusion cannot be made for a single approach or optimal overall management of rotator cuff tears in adults.

Reference:
Seida JC, LeBlanc C, Schouten JR, et al; for Agency for Healthcare Research and Quality. Systematic review: nonoperative and operative treatments for rotator cuff tears: a comparative effectiveness review [published online ahead of print July 5, 2010]. Ann Intern Med.