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. 2008 Jan 23;2008(1):CD005619.
doi: 10.1002/14651858.CD005619.pub2.

Surgery for rotator cuff disease

J A Coghlan, R Buchbinder, S Green, R V Johnston, S N Bell

Surgery for rotator cuff disease

J A Coghlan et al. Cochrane Database Syst Rev. .

Update in

  • Subacromial decompression surgery for rotator cuff disease.
    Karjalainen TV, Jain NB, Page CM, Lähdeoja TA, Johnston RV, Salamh P, Kavaja L, Ardern CL, Agarwal A, Vandvik PO, Buchbinder R. Karjalainen TV, et al. Cochrane Database Syst Rev. 2019 Jan 17;1(1):CD005619. doi: 10.1002/14651858.CD005619.pub3. Cochrane Database Syst Rev. 2019. PMID: 30707445 Free PMC article.

Abstract

Background: This review is one in a series of Cochrane reviews of interventions for shoulder disorders.

Objectives: To determine the effectiveness and safety of surgery for rotator cuff disease.

Search strategy: We searched the Cochrane Controlled Trials Register, (The Cochrane Library Issue 1, 2006), MEDLINE, EMBASE, CINAHL, Sports Discus, Science Citation Index (Web of Science) in March 2006 unrestricted by date or language.

Selection criteria: Only studies described as randomised or quasi-randomised clinical trials (RCTs) studying participants with rotator cuff disease and surgical interventions compared to placebo, no treatment, or any other treatment were included.

Data collection and analysis: Two independent review authors assessed methodological quality of each included trial and extracted data.

Main results: We included 14 RCTs involving 829 participants. Eleven trials included participants with impingement, two trials included participants with rotator cuff tear and one trial included participants with calcific tendinitis. No study met all methodological quality criteria and minimal pooling could be performed. Three trials compared either open or arthroscopic subacromial decompression with active non operative treatment (exercise programme, physiotherapy regimen of exercise and education, or graded physiotherapy strengthening program). No differences in outcome between these treatment groups were reported in any of these trials. One trial which also included a placebo arm (12 sessions detuned soft laser) reported that the Neer score of participants in both active treatment arms improved significantly more than those who received placebo at six months. Six trials that compared arthroscopic with open subacromial decompression reported no significant differences in outcome between groups at any time point although four trials reported a quicker recovery and/or return to work with arthroscopic decompression. Adverse events, which occurred in three trials and included infection, capsulitis, pain, deltoid atrophy, and reoperation, did not differ between surgical groups.

Authors' conclusions: Based upon our review of 14 trials examining heterogeneous interventions and all susceptible to bias, we cannot draw firm conclusions about the effectiveness or safety of surgery for rotator cuff disease. There is "Silver" (www.cochranemsk.org) level evidence from three trials that there are no significant differences in outcome between open or arthroscopic subacromial decompression and active non-operative treatment for impingement. There is also "Silver" level evidence from six trials that there are no significant differences in outcome between arthroscopic and open subacromial decompression although four trials reported earlier recovery with arthroscopic decompression.

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Conflict of interest statement

No author in this review has any known conflict of interest in regard to this review. Simon Bell is an orthopaedic surgeon.

Figures

Analysis 1.1
Analysis 1.1
Comparison 1 Open or arthroscopic subacromial decompression versus active non‐operative treatment or placebo for impingem., Outcome 1 Mean change in Constant score.
Analysis 1.2
Analysis 1.2
Comparison 1 Open or arthroscopic subacromial decompression versus active non‐operative treatment or placebo for impingem., Outcome 2 Mean PRIM score at 12 months.
Analysis 1.3
Analysis 1.3
Comparison 1 Open or arthroscopic subacromial decompression versus active non‐operative treatment or placebo for impingem., Outcome 3 Constant score >80 at 12 months.
Analysis 1.4
Analysis 1.4
Comparison 1 Open or arthroscopic subacromial decompression versus active non‐operative treatment or placebo for impingem., Outcome 4 Success (reduction of 100% pain score from baseline).
Analysis 1.5
Analysis 1.5
Comparison 1 Open or arthroscopic subacromial decompression versus active non‐operative treatment or placebo for impingem., Outcome 5 Success and partial success (reduction 100% pain score or reduction 51‐99% pain score from baseline).
Analysis 2.1
Analysis 2.1
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 1 Mean UCLA score.
Analysis 2.2
Analysis 2.2
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 2 Good or excellent UCLA score.
Analysis 2.3
Analysis 2.3
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 3 Mean Constant score at 12 months.
Analysis 2.4
Analysis 2.4
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 4 Mean participant evaluation of outcome of operation (VAS 0‐100).
Analysis 2.5
Analysis 2.5
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 5 Participant evaluation ‐moderately or completely improved following operation (12 months).
Analysis 2.6
Analysis 2.6
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 6 Participant evaluation‐ satisfied versus somewhat satisfied or not satisfied with operation (12‐49 months).
Analysis 2.7
Analysis 2.7
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 7 Participant evaluation ‐ satisfied versus not satisfied with operation at 12 months.
Analysis 2.8
Analysis 2.8
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 8 Mean pain at rest (VAS 0‐100).
Analysis 2.9
Analysis 2.9
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 9 Mean pain during activity (VAS 0‐100).
Analysis 2.10
Analysis 2.10
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 10 Mean range of movement at 12 months.
Analysis 2.11
Analysis 2.11
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 11 Mean muscle strength (total work, joules): External rotation at 60 degrees/sec.
Analysis 2.12
Analysis 2.12
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 12 Mean muscle strength (total work, joules): External rotation at 180 degrees/sec.
Analysis 2.13
Analysis 2.13
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 13 Mean muscle strength (total work, joules): Internal rotation at 60 degrees/sec.
Analysis 2.14
Analysis 2.14
Comparison 2 Arthroscopic versus open subacromial decompression for impingement syndrome, Outcome 14 Mean muscle strength (total work, joules): Internal rotation at 180 degrees/sec.
Analysis 3.1
Analysis 3.1
Comparison 3 Arthroscopic subacromial decompression ‐ Holium laser versus electrocautery for impingement syndrome, Outcome 1 Mean UCLA score.
Analysis 3.2
Analysis 3.2
Comparison 3 Arthroscopic subacromial decompression ‐ Holium laser versus electrocautery for impingement syndrome, Outcome 2 Mean ASES score.
Analysis 4.1
Analysis 4.1
Comparison 4 Open versus arthroscopic removal of calcium for calcific tendinitis, Outcome 1 Mean shoulder function (VAS) at 16 months.
Analysis 4.2
Analysis 4.2
Comparison 4 Open versus arthroscopic removal of calcium for calcific tendinitis, Outcome 2 Mean pain score (VAS) at 16 months.
Analysis 4.3
Analysis 4.3
Comparison 4 Open versus arthroscopic removal of calcium for calcific tendinitis, Outcome 3 Mean time of physiotherapy (weeks).
Analysis 4.4
Analysis 4.4
Comparison 4 Open versus arthroscopic removal of calcium for calcific tendinitis, Outcome 4 Mean incapacity to work (weeks).
Analysis 5.1
Analysis 5.1
Comparison 5 Open repair of rotator cuff ‐ comparison of two suture materials, Outcome 1 Satisfaction: Would agree to have the operation again at 2 years.
Analysis 5.2
Analysis 5.2
Comparison 5 Open repair of rotator cuff ‐ comparison of two suture materials, Outcome 2 Outcome rated as good or excellent at 2 years.
Analysis 5.3
Analysis 5.3
Comparison 5 Open repair of rotator cuff ‐ comparison of two suture materials, Outcome 3 Rate of retear of the rotator cuff on sonography at 2 years.
Analysis 5.4
Analysis 5.4
Comparison 5 Open repair of rotator cuff ‐ comparison of two suture materials, Outcome 4 Constant score > 75.
Analysis 6.1
Analysis 6.1
Comparison 6 Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression, Outcome 1 Mean ASES score at 12 months.
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References

References to studies included in this review

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References to studies excluded from this review

    1. Alvarez M, Litchfield R, Jackowski D, Griffin S, Kirkley A. A prospective, double blind randomized clinical trial comparing subacromial injection of betamethasone and xylocaine to xylocaine alone in chronic rotator cuff tendinosis. The American Journal of Sports Medicine 2005;33(2):255‐62. - PubMed
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References to studies awaiting assessment

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