Irreparable cuff tears – how ought to they be handled?

Low stage of proof for all therapy modalities for irreparable posterosuperior rotator cuff tears

These authors performed a scientific overview to evaluate proof for enhancements in end result for all reported varieties of therapy modalities [physical therapy, tenotomy or tenodesis of the long head of the biceps, debridement, partial repair, subacromial spacer, deltoid flap, muscle transfer, rotator cuff advancement, graft interposition, superior capsular reconstruction (SCR), and reversed shoulder arthroplasty (RSA)] used for irreparable posterosuperior rotator cuff tears with out glenohumeral osteoarthritis in articles revealed from January 2007 till January 2019, with minimal 2-year follow-up.

Sixty research (2000 sufferers) have been included with truthful imply high quality in response to the Modified Coleman Methodology Rating.

The employed definitions of ‘irreparable’ have been primarily based mostly on MRI standards and have been extremely variable amongst research.

The weighted imply preoperative to post-operative enhancements in Fixed Rating are proven:

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Therapies deltoid flap, muscle switch, and debridement have been the one remedies with out there long-term (eight–10-year) follow-up and confirmed comparable enhancements in Fixed Rating at the moment level.

Remark: The authors level out that variability in affected person traits, co-interventions, end result reporting, and size of follow-up in research on irreparable rotator cuff tears with out osteoarthritis complicates sound comparability of remedies. It’s of notice that clinically essential therapy results have been seen for all 11 totally different therapy modalities. The worth of every of those remedies may be considered because the profit to the affected person divided by the fee, time to restoration and dangers of every therapy.

In that randomized management trials evaluating totally different approaches to the administration of irreparable cuff tears are unlikely to be carried out, we might want to depend on comparative information resembling these offered on this paper to judge which remedies are optimum for which sufferers. These comparisons shall be facilitated if medical experiences can absolutely characterize the sufferers, the shoulders, the remedies, and the end result measures.


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