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Meta-Analysis
. 2019 Dec 9;12(12):CD013502.
doi: 10.1002/14651858.CD013502.

Surgery for rotator cuff tears

Teemu V Karjalainen  1 , Nitin B Jain  2 , Juuso Heikkinen  3 , Renea V Johnston  4 , Cristina M Page  2 , Rachelle Buchbinder  4
Affiliations
Meta-Analysis

Surgery for rotator cuff tears

Teemu V Karjalainen et al. Cochrane Database Syst Rev. .

Abstract

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

Objectives: To synthesise the available evidence regarding the benefits and harms of rotator cuff repair with or without subacromial decompression in the treatment of rotator cuff tears of the shoulder.

Search methods: We searched the CENTRAL, MEDLINE, Embase, Clinicaltrials.gov and WHO ICRTP registry unrestricted by date or language until 8 January 2019.

Selection criteria: Randomised controlled trials (RCTs) including adults with full-thickness rotator cuff tears and assessing the effect of rotator cuff repair compared to placebo, no treatment, or any other treatment were included. As there were no trials comparing surgery with placebo, the primary comparison was rotator cuff repair with or without subacromial decompression versus non-operative treatment (exercises with or without glucocorticoid injection). Other comparisons were rotator cuff repair and acromioplasty versus rotator cuff repair alone, and rotator cuff repair and subacromial decompression versus subacromial decompression alone. Major outcomes were mean pain, shoulder function, quality of life, participant-rated global assessment of treatment success, adverse events and serious adverse events. The primary endpoint for this review was one year.

Data collection and analysis: We used standard methodologic procedures expected by Cochrane.

Main results: We included nine trials with 1007 participants. Three trials compared rotator cuff repair with subacromial decompression followed by exercises with exercise alone. These trials included 339 participants with full-thickness rotator cuff tears diagnosed with magnetic resonance imaging (MRI) or ultrasound examination. One of the three trials also provided up to three glucocorticoid injections in the exercise group. All surgery groups received tendon repair with subacromial decompression and the postoperative exercises were similar to the exercises provided for the non-operative groups. Five trials (526 participants) compared repair with acromioplasty versus repair alone; and one trial (142 participants) compared repair with subacromial decompression versus subacromial decompression alone. The mean age of trial participants ranged between 56 and 68 years, and females comprised 29% to 56% of the participants. Symptom duration varied from a mean of 10 months up to 28 months. Two trials excluded tears with traumatic onset of symptoms. One trial defined a minimum duration of symptoms of six months and required a trial of conservative therapy before inclusion. The trials included mainly repairable full-thickness supraspinatus tears, six trials specifically excluded tears involving the subscapularis tendon. All trials were at risk of bias for several criteria, most notably due to lack of participant and personnel blinding, but also for other reasons such as unclearly reported methods of random sequence generation or allocation concealment (six trials), incomplete outcome data (three trials), selective reporting (six trials), and other biases (six trials). Our main comparison was subacromial decompression versus non-operative treatment and results are reported for the 12 month follow up. At one year, moderate-certainty evidence (downgraded for bias) from 3 trials with 258 participants indicates that surgery probably provides little or no improvement in pain; mean pain (range 0 to 10, higher scores indicate more pain) was 1.6 points with non-operative treatment and 0.87 points better (0.43 better to 1.30 better) with surgery.. Mean function (zero to 100, higher score indicating better outcome) was 72 points with non-operative treatment and 6 points better (2.43 better to 9.54 better) with surgery (3 trials; 269 participants), low-certainty evidence (downgraded for bias and imprecision). Participant-rated global success rate was 873/1000 after non-operative treatment and 943/1000 after surgery corresponding to (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.96 to 1.22; low-certainty evidence (downgraded for bias and imprecision). Health-related quality of life was 57.5 points (SF-36 mental component score, 0 to 100, higher score indicating better quality of life) with non-operative treatment and 1.3 points worse (4.5 worse to 1.9 better) with surgery (1 trial; 103 participants), low-certainty evidence (downgraded for bias and imprecision). We were unable to estimate the risk of adverse events and serious adverse events as only one event was reported across the trials (very low-certainty evidence; downgraded once due to bias and twice due to very serious imprecision).

Authors' conclusions: At the moment, we are uncertain whether rotator cuff repair surgery provides clinically meaningful benefits to people with symptomatic tears; it may provide little or no clinically important benefits with respect to pain, function, overall quality of life or participant-rated global assessment of treatment success when compared with non-operative treatment. Surgery may not improve shoulder pain or function compared with exercises, with or without glucocorticoid injections. The trials included have methodology concerns and none included a placebo control. They included participants with mostly small degenerative tears involving the supraspinatus tendon and the conclusions of this review may not be applicable to traumatic tears, large tears involving the subscapularis tendon or young people. Furthermore, the trials did not assess if surgery could prevent arthritic changes in long-term follow-up. Further well-designed trials in this area that include a placebo-surgery control group and long follow-up are needed to further increase certainty about the effects of surgery for rotator cuff tears.

PubMed Disclaimer

Conflict of interest statement

Nitin Jain is performing a trial comparing surgery with non‐operative treatment (NCT03295994) and Rachelle Buchbinder is an external advisor on this project. Nitin Jain's contributions for this review are partially covered by grants from NIH and PCORI.

Renea Johnston is the Managing Editor of Cochrane Musculoskeletal, but is not involved in editorial decisions regarding this review. She is a recipient of an NHMRC (Australia) Cochrane Collaboration Round 7 Funding Program Grant, which supports the Cochrane Musculoskeletal Australian Editorial base, but the funding source did not participate in the conduct of this review.

Rachelle Buchbinder is the Co‐ordinating Editor of Cochrane Musculoskeletal but is not involved in editorial decisions regarding this review. She has received royalties from Wolters Kluwer Health for writing a chapter on plantar fasciitis in UpToDate. She is a recipient of a National Health and Medical Research Council (NHMRC) Cochrane Collaboration Round 7 Funding Program Grant, which supports the activities of Cochrane Musculoskeletal ‐ Australia and Cochrane Australia, but the funders do not participate in the conduct of reviews.

Teemu Karjalainen's time for this review is funded by the Finnish Medical Association through a grant from non‐profit foundation to support research work. He received money from Summed Finland (representative of Acumed surgical instruments) for travel expenses to participate in upper extremity trauma course organised by Acumed in June 2017.

Juuso Heikkinen and Cristina Page: none known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study.
1.1
1.1. Analysis
Comparison 1 Repair with or without subacromial decompression versus non‐operative treatment, Outcome 1 Pain (VAS; 0‐10, 0 is best).
1.2
1.2. Analysis
Comparison 1 Repair with or without subacromial decompression versus non‐operative treatment, Outcome 2 Function (Constant score; 0‐100, 100 is best).
1.3
1.3. Analysis
Comparison 1 Repair with or without subacromial decompression versus non‐operative treatment, Outcome 3 Participant rated global assessment of success.
1.4
1.4. Analysis
Comparison 1 Repair with or without subacromial decompression versus non‐operative treatment, Outcome 4 Health‐related quality of life (SF‐36 mental component, 0‐100, 100 is best).
2.1
2.1. Analysis
Comparison 2 Repair with acromioplasty versus repair only, Outcome 1 Pain (0 to 10, 0 is best).
2.2
2.2. Analysis
Comparison 2 Repair with acromioplasty versus repair only, Outcome 2 Function (0 to 100, 100 is best).
2.3
2.3. Analysis
Comparison 2 Repair with acromioplasty versus repair only, Outcome 3 Repair failure.
2.4
2.4. Analysis
Comparison 2 Repair with acromioplasty versus repair only, Outcome 4 Adverse events.
2.5
2.5. Analysis
Comparison 2 Repair with acromioplasty versus repair only, Outcome 5 Subgroup analysis by acromion type for pain at 2 years.
2.6
2.6. Analysis
Comparison 2 Repair with acromioplasty versus repair only, Outcome 6 Subgroup analysis by acromion type for function at 2 years (various measures 0 to 100, higher is better).
3.1
3.1. Analysis
Comparison 3 Repair with subacromial decompression versus subacomial decompression alone, Outcome 1 Pain (VAS; 0 to 10, 0 is best).
3.2
3.2. Analysis
Comparison 3 Repair with subacromial decompression versus subacomial decompression alone, Outcome 2 Function (Constant score 0 to 100, 100 is best).
3.3
3.3. Analysis
Comparison 3 Repair with subacromial decompression versus subacomial decompression alone, Outcome 3 Participant‐rated global assessment of success.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Abrams 2014 {published data only}
    1. Abrams GD, Gupta AK, Hussey KE, Tetteh ES, Karas V, Bach BR Jr, et al. Arthroscopic repair of full‐thickness rotator cuff tears with and without acromioplasty: randomized prospective trial with 2‐year follow‐up. American Journal of Sports Medicine 2014;42(6):1296‐303. [PUBMED: 24733157] - PubMed
    1. Tetteh ES, Hussey EK, Abrams GD, Gupta AK, Dhawan A, Karas V, et al. A prospective randomized trial of functional outcomes following rotator cuff repair with and without acromioplasty. Orthopedic Journal of Sports Medicine 2013;1(4 suppl):PMCID: PMC4588967.
    1. Waterman BR, Newgren J, Gowd AK, Cabarcas BC, Bach BR, Cole BJ, et al. Randomized prospective trial of arthroscopic rotator cuff with or without acromioplasty: no difference in patient‐reported outcomes at long‐term follow‐up. Orthopaedic Journal of Sports Medicine 2018;6((7 suppl 4)):no pagination. - PubMed
Dezaly 2011 {published data only}
    1. Dezaly C, Sirveaux F, Philippe R, Wein‐Remy F, Sedaghatian J, Roche O, et al. Arthroscopic treatment of rotator cuff tear in the over‐60s: repair is preferable to isolated acromioplasty‐tenotomy in the short term. Orthopaedics & Traumatology, Surgery & Research : OTSR 2011;97(6 Suppl):S125‐30. [PUBMED: 21798838] - PubMed
    1. Jacquot A, Dezaly C, Goetzmann T, Roche O, Sirveaux F, Mole D. Is rotator cuff repair appropriate in patients older than 60 years of age? prospective, randomised trial in 103 patients with a mean four‐year follow‐up. Orthopaedics & Traumatology, Surgery & Research : OTSR 2014;100(6 Suppl):S333‐8. [PUBMED: 25155203] - PubMed
Gartsman 2004 {published data only}
    1. Gartsman GM, O'connor DP. Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: a prospective, randomized study of one‐year outcomes. Journal of Shoulder and Elbow Surgery 2004;13(4):424‐6. [PUBMED: 15220883] - PubMed
Kukkonen 2014 {published data only}
    1. Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EK, Kauko T, et al. Treatment of non‐traumatic rotator cuff tears ‐ A randomised controlled trial with one‐year clinical results. The Bone and Joint Journal 2014;96‐B:75–81. - PubMed
    1. Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EK, Kauko T, et al. Treatment of nontraumatic rotator cuff tears: a randomized controlled trial with two years of clinical and imaging follow‐up. Journal of Bone and Joint Surgery. American volume 2015;97(21):1729‐37. [PUBMED: 26537160] - PubMed
Lambers Heerspink 2015 {published data only}
    1. Lambers Heerspink FO, Raay JJ, Koorevaar RC, Eerden PJ, Westerbeek RE, ’t Roet E, et al. Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial. Journal of Shoulder and Elbow Surgery 2015;24(8):1274‐81. - PubMed
MacDonald 2011 {published data only}
    1. MacDonald P, McRae S, Leiter J, Mascarenhas R, Lapner P. Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full‐thickness rotator cuff tears: a multicenter, randomized controlled trial. Journal of Bone and Joint Surgery. American volume 2011;93(21):1953‐60. [PUBMED: 22048089] - PubMed
    1. Mascaranhas R. Arthroscopic rotator cuff repair with and without acromiplasty in the treatment of full‐thickness rotator cuff tears: A multi‐centre, randomized controlled trial. Arthroscopy 2011;27(10 (Suppl)):e142–3. - PubMed
Milano 2007 {published data only}
    1. Milano G, Grasso A, Salvatore M, Zarelli D, Deriu L, Fabbriciani C. Arthroscopic rotator cuff repair with and without subacromial decompression: a prospective randomized study. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2007;23(1):81‐8. [PUBMED: 17210431] - PubMed
Moosmayer 2010 {published data only}
    1. Moosmayer S, Lund G, Seljom U, Svege I, Hennig T, Tariq R, et al. Comparison between surgery and physiotherapy in the treatment of small and medium‐sized tears of the rotator cuff: A randomised controlled study of 103 patients with one‐year follow‐up. Journal of Bone and Joint Surgery. British volume 2010;92(1):83‐91. - PubMed
    1. Moosmayer S, Lund G, Seljom US, Haldorsen B, Svege IC, Hennig T, et al. Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five‐year follow‐up. Journal of Bone and Joint Surgery: American volume 2014;96(18):1504‐14. - PubMed
Shin 2012 {published data only}
    1. Shin SJ, Oh JH, Chung SW, Song MH. The efficacy of acromioplasty in the arthroscopic repair of small‐ to medium‐sized rotator cuff tears without acromial spur: prospective comparative study. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2012;28(5):628‐35. [PUBMED: 22261136] - PubMed

References to studies excluded from this review

Berth 2010 {published data only}
    1. Berth A, Neumann W, Awiszus F, Pap G. Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. Journal of Orthopaedics and Traumatology : official journal of the Italian Society of Orthopaedics and Traumatology 2010;11(1):13‐20. [PUBMED: 20198404] - PMC - PubMed
Flurin 2013 {published data only}
    1. Flurin PH, Hardy P, Abadie P, Desmoineaux P, Essig J, Joudet T, et al. Rotator cuff tears after 70 years of age: a prospective, randomized, comparative study between decompression and arthroscopic repair in 154 patients. Orthopaedics & Traumatology, Surgery & Research : OTSR 2013;99(8 Suppl):S371‐8. [PUBMED: 24211128] - PubMed
Franceschi 2013 {published data only}
    1. Franceschi F, Papalia R, Buono A, Vasta S, Costa V, Maffulli N, et al. Articular‐sided rotator cuff tears: which is the best repair? A three‐year prospective randomised controlled trial. International Orthopaedics 2013;37(8):1487‐93. [PUBMED: 23580030] - PMC - PubMed
Franceschi 2015 {published data only}
    1. Franceschi F, Papalia R, Vasta S, Leonardi F, Maffulli N, Denaro V. Surgical management of irreparable rotator cuff tears. Knee surgery, Sports Traumatology, Arthroscopy : official journal of the ESSKA 2015;23(2):494‐501. [PUBMED: 23212188] - PubMed
Heuberer 2016 {published data only}
    1. Heuberer PR, Kolblinger R, Buchleitner S, Pauzenberger L, Laky B, Auffarth A, et al. Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration. Knee Surgery, Sports Traumatology, Arthroscopy : official journal of the ESSKA 2016;24(12):3828‐37. [PUBMED: 26254089] - PubMed
Maillot 2018 {published data only}
    1. Maillot C, Harly E, Demezon H, Huec JC. Surgical repair of large‐to‐massive rotator cuff tears seems to be a better option than patch augmentation or debridement and biceps tenotomy: a prospective comparative study. Journal of Shoulder and Ebow Surgery 2018;27(9):1545‐52. [PUBMED: 29980338] - PubMed
Mardani‐Kivi 2016 {published data only}
    1. Mardani‐Kivi M, Karimi A, Keyhani S, Hashemi‐Motlagh K, Saheb‐Ekhtiari K. Rotator Cuff Repair: Is there any role for acromioplasty?. Physician and Sportsmedicine 2016;44(3):274‐7. [PUBMED: 27476731] - PubMed
Shin 2012a {published data only}
    1. Shin SJ. A comparison of 2 repair techniques for partial‐thickness articular‐sided rotator cuff tears. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2012;28(1):25‐33. [PUBMED: 22000411] - PubMed

References to studies awaiting assessment

Lhee 2013 {published data only}
    1. Lhee SH. Prospective randomized comparative study of 191 subscapularis tear: clinical and radiologic outcome – arthroscopic repair vs debridement. Journal of Elbow and Shoulder Surgery Vol. 22, issue 10:e24‐5.
    1. Lhee SH. Prospective randomized comparative study of outcome of subscapularis tear. https://clinicaltrials.gov/ct2/show/nct01996904 November 2013.

References to ongoing studies

NCT00695981 {published data only}
    1. Paloneva J. Operative versus non‐operative management of rotator cuff tear. https://clinicaltrials.gov/ct2/show/NCT00695981.
NCT01498198 {published data only}
    1. MacDonald P. Workers Compensation Board: rotator cuff tear management. https://clinicaltrials.gov/ct2/show/NCT01498198.
NCT02059473 {published data only}
    1. Hallgren H. Treatment of small acute cuff tears, a randomized study. https://clinicaltrials.gov/ct2/show/NCT02059473.
NCT02885714 {published data only}
    1. Äärimaa V, Ryösä A. ACCURATE Trial ‐ operative treatment of acute rotator cuff tear related to trauma. https://clinicaltrials.gov/ct2/show/NCT02885714.
NCT03183466 {published data only}
    1. Samsung Medical Center. Do you arthroscopic repair for subscapularis tendon tear, which accounts for more than half of the 1st facet? or do you perform debridement?. https://clinicaltrials.gov/ct2/show/NCT03183466.
NCT03295994 {published data only}
    1. Nitin J. Operative versus non‐operative treatment for atraumatic rotator cuff tears (ARC). https://clinicaltrials.gov/ct2/show/NCT03295994.

Additional references

Bennell 2007
    1. Bennell K, Coburn S, Wee E, Green S, Harris A, Forbes A, et al. Efficacy and cost‐effectiveness of a physiotherapy program for chronic rotator cuff pathology: a protocol for a randomised, double‐blind, placebo‐controlled trial. BMC Musculoskeletal Disorders 2007;8(86):1‐12. - PMC - PubMed
Buchbinder 2003
    1. Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database of Systematic Reviews 2003, Issue 1. [DOI: 10.1002/14651858.CD004016] - DOI - PMC - PubMed
Buchbinder 2011
    1. Buchbinder R, Johnston RV, Roos JF. Shock wave therapy for rotator cuff disease with or without calcification. Cochrane Database of Systematic Reviews 2011, Issue 1. [DOI: 10.1002/14651858.CD008962] - DOI - PMC - PubMed
Buchbinder 2017
    1. Buchbinder R, Page MJ, Huang H, Verhagen AP, Beaton D, Kopkow C, et al. for the Shoulder Core Outcomes Set Special Interest Group. A preliminary Core Domain Set for clinical trials of shoulder disorders: a report from the OMERACT 2016 Shoulder Core Outcome Set Special Interest Group. Journal of Rheumatology 2017;44(12):1880‐3. - PubMed
Cates 2008 [Computer program]
    1. Dr. Christopher Cates EBM web site. URL: http://www.nntonline.net. Visual Rx. Version 3. Dr. Christopher Cates EBM web site. URL: http://www.nntonline.net, 2008.
Chahal 2012
    1. Chahal J, Mall N, MacDonald PB, Thiel G, Cole BJ, Romeo AA, et al. The role of subacromial decompression in patients undergoing arthroscopic repair of full‐thickness tears of the rotator cuff: a systematic review and meta‐analysis. Arthroscopy : the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2012;28(5):720‐7. [PUBMED: 22305327] - PubMed
Chard 1991
    1. Chard MD, Hazleman R, Hazleman BL, King RH, Reiss BB. Shoulder disorders in the elderly: a community survey. Arthritis and Rheumatism 1991;34:766‐9. - PubMed
Chaudhury 2012
    1. Chaudhury S, Dines JS, Delos D, Warren RF, Voigt C, Rodeo SA. Role of fatty infiltration in the pathophysiology and outcomes of rotator cuff tears. Arthritis Care & Research 2012;64(1):76‐82. [PUBMED: 21770040] - PubMed
Chillemi 2016
    1. Chillemi C, Petrozza V, Franceschini V, Garro L, Pacchiarotti A, Porta N, et al. The role of tendon and subacromial bursa in rotator cuff tear pain: a clinical and histopathological study. Knee Surgery, Sports Traumatology, Arthroscopy : official journal of the ESSKA 2016;24(12):3779‐86. [PUBMED: 26003482] - PubMed
Coghlan 2008
    1. Coghlan JA, Buchbinder R, Green S, Johnston RV, Bell SN. Surgery for rotator cuff disease. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD005619.pub2] - DOI - PMC - PubMed
Cumpston 2009
    1. Cumpston M, Johnston RV, Wengier L, Buchbinder R. Topical glyceryl trinitrate for rotator cuff disease. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD006355.pub2] - DOI - PubMed
Curry 2015
    1. Curry EJ, Matzkin EE, Dong Y, Higgins LD, Katz JN, Jain NB. Structural characteristics are not associated with pain and function in rotator cuff tears. Orthopaedic Journal of Sports Medicine 2015;3(5):2325967115584596. [PUBMED: 26675985] - PMC - PubMed
Dabija 2017
    1. Dabija DI, Gao C, Edwards TL, Kuhn JE, Jain NB. Genetic and familial predisposition to rotator cuff disease: a systematic review. Journal of Shoulder and Elbow Surgery 2017;26(6):1103‐12. [PUBMED: 28162885] - PMC - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JP, Altman DG (editors). Chapter 9: Analysing data and undertaking meta‐analyses.In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Dinnes 2003
    1. Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technology Assessment 2003;7(29):1‐166. - PubMed
Dunn 2014
    1. Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY, et al. Symptoms of pain do not correlate with rotator cuff tear severity: a cross‐sectional study of 393 patients with a symptomatic atraumatic full‐thickness rotator cuff tear. Journal of Bone and Joint Surgery. American volume 2014;96(10):793‐800. [PUBMED: 24875019] - PMC - PubMed
Dwan 2011
    1. Dwan K, Altman DG, Cresswell L, Blundell M, Gamble CL, Williamson PR. Comparison of protocols and registry entries to published reports for randomised controlled trials. Cochrane Database of Systematic Reviews 2011, Issue 1. [DOI: 10.1002/14651858.MR000031.pub2] - DOI - PMC - PubMed
Engebretsen 2009
    1. Engebretsen K, Grotle M, Bautz‐Holter E, Sandvik L, Juel NG, Ekeberg OM, et al. Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single randomised study. BMJ 2009;339:b3360. - PMC - PubMed
Familiari 2015
    1. Familiari F, Gonzalez‐Zapata A, Ianno B, Galasso O, Gasparini G, McFarland EG. Is acromioplasty necessary in the setting of full‐thickness rotator cuff tears? A systematic review. Journal of Orthopaedics and Traumatology : official journal of the Italian Society of Orthopaedics and Traumatology 2015;16(3):167‐74. [PUBMED: 26003837] - PMC - PubMed
Franceschi 2011
    1. Franceschi F, Papalia R, Buono A, Maffulli N, Denaro V. Repair of partial tears of the rotator cuff. Sports Medicine and Arthroscopy review 2011;19(4):401‐8. [PUBMED: 22089290] - PubMed
Gagnier 2018
    1. Gagnier JJ, Robbins C, Bedi A, Carpenter JE, Miller BS. Establishing minimally important differences for the American Shoulder and Elbow Surgeons score and the Western Ontario Rotator Cuff Index in patients with full‐thickness rotator cuff tears. Journal of Shoulder and Elbow Surgery 2018;27(5):e160‐6. [PUBMED: 29307675] - PubMed
Gialanella 2011
    1. Gialanella B, Prometti P. Effects of corticosteroids injection in rotator cuff tears. Pain Medicine 2011;12(10):1559‐65. - PubMed
Gombera 2014
    1. Gombera MM, Sekiya JK. Rotator cuff tear and glenohumeral instability : a systematic review. Clinical Orthopaedics and Related Research 2014;472(8):2448‐56. [PUBMED: 24043432] - PMC - PubMed
Gomoll 2004
    1. Gomoll AH, Katz JN, Warner JJP, Millett PJ. Rotator cuff disorders: recognition and management among patients with shoulder pain. Arthritis and Rheumatism 2004;50:3751‐61. - PubMed
Gotoh 1998
    1. Gotoh M, Hamada K, Yamakawa H, Inoue A, Fukuda H. Increased substance P in subacromial bursa and shoulder pain in rotator cuff diseases. Journal of Orthopaedic Research : official publication of the Orthopaedic Research Society 1998;16(5):618‐21. [PUBMED: 9820287] - PubMed
Goutallier 1994
    1. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre‐ and postoperative evaluation by CT scan. Clinical Orthopaedics and Related Research 1994;0(304):78‐83. [PUBMED: 8020238] - PubMed
GRADEpro GDT 2015 [Computer program]
    1. McMaster University (developed by Evidence Prime, Inc.). Available from www.gradepro.org. GRADEpro Guideline Development Tool. McMaster University (developed by Evidence Prime, Inc.). Available from www.gradepro.org, 2015.
Green 1998
    1. Green S, Buchbinder R, Glazier R, Forbes A. Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. BMJ 1998;316:345‐60. - PMC - PubMed
Green 2005
    1. Green S, Buchbinder R, Hetrick S. Acupunture for shoulder pain. Cochrane Database of Systematic Reviews 2005, Issue 2. [DOI: 10.1002/14651858.CD005319] - DOI - PMC - PubMed
Greenspoon 2015
    1. Greenspoon JA, Petri M, Warth RJ, Millett PJ. Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes. Journal of Shoulder and Elbow Surgery 2015;24(9):1493‐505. [PUBMED: 26129871] - PubMed
Hao 2018
    1. Hao Q, Devji T, Zeraatkar D, Wang Y, Qasim A, Siemieniuk R, et al. Minimal important differences in shoulder condition patient‐reported outcomes: a systematic survey to inform a BMJ Rapid Recommendation. BMJ open 2019;9(2):e028777. - PMC - PubMed
Hata 2001
    1. Hata Y, Saitoh S, Murakami N, Seki H, Nakatsuchi Y, Takaoka K. A less invasive surgery for rotator cuff tear: mini‐ open repair. Journal of Shoulder and Elbow Surgery 2001;10(1):11‐6. - PubMed
Hegedus 2010
    1. Hegedus EJ, Cook C, Brennan M, Wyland D, Garrison JC, Driesner D. Vascularity and tendon pathology in the rotator cuff: a review of literature and implications for rehabilitation and surgery. British Journal of Sports Medicine 2010;44(12):838‐47. [PUBMED: 19293165] - PubMed
Hermans 2013
    1. Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL, Bierma‐Zeinstra SM. Does this patient with shoulder pain have rotator cuff disease? The rational clinical examination systematic review. JAMA 2013;310(8):837‐47. - PubMed
Hertling 1990
    1. Hertling D, Kessler RM. The Shoulder and Shoulder Girdle. Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods. Philadelphia: Lippincott. 3rd Edition. Vol. 1, Philadelphia: Lippincott Williams and Wilkins, 1990.
Higgins 2011
    1. Higgins JP, Altman DG, Sterne JA (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hill 2017
    1. Hill JR, McKnight B, Pannell WC, Heckmann N, Sivasundaram L, Mostofi A, et al. Risk factors for 30‐day readmission following shoulder arthroscopy. Arthroscopy 2017;33(1):55‐61. [DOI: 10.1016/j.arthro.2016.06.048] - DOI - PubMed
Huang 2016
    1. Huang R, Wang S, Wang Y, Qin X, Sun Y. Systematic review of all‐arthroscopic versus mini‐openrRepair of rotator cuff tears: a meta‐analysis. Scientific Reports 2016;6:22857. [PUBMED: 26947557] - PMC - PubMed
Jain 2013
    1. Jain NB, Yamaguchi K. History and physical examination provide little guidance on diagnosis of rotator cuff tears. Evidence Based Medicine 2013;19(3):108. - PMC - PubMed
Ji 2015
    1. Ji X, Bi C, Wang F, Wang Q. Arthroscopic versus mini‐open rotator cuff repair: an up‐to‐date meta‐analysis of randomized controlled trials. Arthroscopy: the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2015;31(1):118‐24. [PUBMED: 25442664] - PubMed
Johnson 2004
    1. Johnson MP, Crossley KL, O'Neil ME, Al‐Zakwani IS. Estimates of direct healthcare expenditures among individuals with shoulder dysfunction in the United States. American Society of Shoulder and Elbow Therapists. Available at: http://www.asset‐usa.org/Abstracts/Johnson_Crossley_Oneil_Al‐Kakwani.htm 2004.
Judge 2014
    1. Judge A, Murphy RJ, Maxwell R, Arden NK, Carr AJ. Temporal trends and geographical variation in the use of subacromial decompression and rotator cuff repair of the shoulder in England. Bone & Joint Journal 2014;96‐B(1):70‐4. [PUBMED: 24395314] - PubMed
Karjalainen 2019
    1. Karjalainen TV, Jain NB, Page CM, Lahdeoja TA, Johnston RV, Salamh P, et al. Subacromial decompression surgery for rotator cuff disease. Cochrane Database of Systematic Reviews 2019, Issue 1. [DOI: 10.1002/14651858.CD005619.pub3] - DOI - PMC - PubMed
Kempf 1999
    1. Kempf JF, Gleyze P, Bonnomet F, Walch G, Mole D, Frank A, et al. A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 1999;15(1):56‐66. [PUBMED: 10024034] - PubMed
Kirkham 2010
    1. Kirkham JJ, Altman DG, Williamson PR. Bias due to changes in specified outcomes during the systematic review process. PLOS One 2010;5(3):e9810. [PUBMED: 20339557] - PMC - PubMed
Kuhn 2009
    1. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence‐based rehabilitation protocol. Journal of Shoulder and Elbow Surgery 2009;18(1):138‐60. - PubMed
Lambers Heerspink 2014
    1. Lambers Heerspink FO, Dorrestijn O, Raay JJ, Diercks RL. Specific patient‐related prognostic factors for rotator cuff repair: a systematic review. Journal of Shoulder and Elbow Surgery 2014;23(7):1073‐80. [PUBMED: 24725900] - PubMed
Lenza 2013
    1. Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database of Systematic Reviews 2013, Issue 9. [DOI: 10.1002/14651858.CD009020.pub2] - DOI - PMC - PubMed
Luime 2004
    1. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian Journal of Rheumatology 2004;33(2):73‐81. [PUBMED: 15163107] - PubMed
Mall 2010
    1. Mall NA, Kim HM, Keener JD, Steger‐May K, Teefey SA, Middleton WD, et al. Symptomatic progression of asymptomatic rotator cuff tears: A prospective study of clinical and sonographic variables. Journal of Bone and Joint Surgery. American volume 2010;92:2623‐33. - PMC - PubMed
Mall 2014
    1. Mall NA, Tanaka MJ, Choi LS, Paletta GA Jr. Factors affecting rotator cuff healing. Journal of Bone and Joint Surgery. American volume 2014;96(9):778‐88. [PUBMED: 24806015] - PubMed
Millett 2006
    1. Millett PJ, Wilcox RB, 3rd, O'Holleran JD, Warner JJ. Rehabilitation of the rotator cuff: an evaluation‐based approach. Journal of the American Academy of Orthopaedic Surgeons 2006;14(11):599‐609. - PubMed
Misamore 1995
    1. Misamore GW, Ziegler DW, Rushton JL, 2nd. Repair of the rotator cuff. A comparison of results in two populations of patients. Journal of Bone and Joint Surgery. American volume 1995;77(9):1335‐9. - PubMed
Moosmayer 2009
    1. Moosmayer S, Smith HJ, Tariq R, Larmo A. Prevalence and characteristics of asymptomatic tears of the rotator cuff: an ultrasonographic and clinical study. Journal of Bone and Joint Surgery. British volume 2009;91(2):196‐200. [PUBMED: 19190053] - PubMed
Moosmayer 2013
    1. Moosmayer S, Tariq R, Stiris M, Smith HJ. The natural history of asymptomatic rotator cuff tears: a three‐year follow‐up of fifty cases. Journal of Bone and Joint Surgery. American volume 2013;95(14):1249‐55. [PUBMED: 23864172] - PubMed
Morelli 2019
    1. Morelli KM, Martin BR, Charakla FH, Durmisevic A, Warren GL. Acromion morphology and prevalence of rotator cuff tear: A systematic review and meta‐analysis. Clinical anatomy (New York, N.Y.) 2019;32(1):122‐30. [PUBMED: 30362636] - PubMed
Nam 2012
    1. Nam D, Maak TG, Raphael BS, Kepler CK, Cross MB, Warren RF. Rotator cuff tear arthropathy: evaluation, diagnosis, and treatment: AAOS exhibit selection. Journal of Bone and Joint surgery. American volume 2012;94(6):e34. [PUBMED: 22438007] - PubMed
Neer 1983
    1. Neer CS. Impingement lesions. Clinical Orthopaedics and Related Research 1983;173:70‐7. - PubMed
Nho 2007
    1. Nho SJ, Shindle MK, Sherman SL, Freedman KB, Lyman S, MacGillivray JD. Systematic review of arthroscopic rotator cuff repair and mini‐open rotator cuff repair. Journal of Bone and Joint Surgery. American volume 2007;89(Suppl 3):127‐36. - PubMed
Nho 2009
    1. Nho SJ, Brown BS, Lyman S, Adler RS, Altchek DW, MacGillivray JD. Prospective analysis of arthroscopic rotator cuff repair: Prognostic factors affecting clinical and ultrasound outcome. Journal of Shoulder and Elbow Surgery 2009;18(1):13‐20. [PUBMED: 18799326] - PubMed
Page 2015
    1. Page MJ, McKenzie JE, Green SE, Beaton DE, Jain NB, Lenza M, et al. Core domains and outcome measurement sets for shoulder pain trials are needed: systematic review of physical therapy trials. Journal of Clinical Epidemiology 2015;68:1270‐81. - PMC - PubMed
Page 2016a
    1. Page MJ, Green S, McBain B, Surace SJ, Deitch J, Lyttle N, et al. Manual therapy and exercise for rotator cuff disease. Cochrane Database of Systematic Reviews 2016, Issue 6. [DOI: 10.1002/14651858.CD012224] - DOI - PMC - PubMed
Page 2016b
    1. Page MJ, Green S, Mrocki MA, Surace SJ, Deitch J, McBain B, et al. Electrotherapy modalities for rotator cuff disease. Cochrane Database of Systematic Reviews 2016, Issue 6. [DOI: 10.1002/14651858.CD012225] - DOI - PMC - PubMed
Pedowitz 2012
    1. Pedowitz RA, Yamaguchi K, Ahmad CS, Burks RT, Flatow EL, Green A, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on: optimizing the management of rotator cuff problems. Journal of Bone and Joint Surgery. American volume 2012;94(2):163‐7. - PubMed
Piper 2018
    1. Piper CC, Hughes AJ, Ma Y, Wang H, Neviaser AS. Operative versus non‐perative treatment for the management of full‐thickness rotator cuff tears: a systematic review and meta‐analysis. Journal of Shoulder and Elbow Surgery 2018;27(3):572‐6. [PUBMED: 29169957] - PubMed
Reilly 2006
    1. Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJ. Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Annals of the Royal College of Surgeons of England 2006;88(2):116‐21. [PUBMED: 16551396] - PMC - PubMed
Rekola 1993
    1. Rekola KE, Keinanen‐Kiukaanniemi S, Takala J. Use of primary health services in sparsely populated country districts by patients with musculoskeletal symptoms: consultations with a physician. Journal of Epidemiology and Community Health 1993;47(2):153‐7. [PUBMED: 8326275] - PMC - PubMed
Rugg 2018
    1. Rugg CM, Gallo RA, Craig EV, Feeley BT. The pathogenesis and management of cuff tear arthropathy. Journal of Shoulder and Elbow Surgery 2018;27(12):2271‐83. [PUBMED: 30268586] - PubMed
Ryosa 2017
    1. Ryosa A, Laimi K, Aarimaa V, Lehtimaki K, Kukkonen J, Saltychev M. Surgery or conservative treatment for rotator cuff tear: a meta‐analysis. Disability and Rehabilitation 2017;39(14):1357‐63. [PUBMED: 27385156] - PubMed
Savovic 2012
    1. Savovic J, Jones H, Altman D, Harris R, Juni P, Pildal J, et al. Influence of reported study design characteristics on intervention effect estimates from randomised controlled trials: combined analysis of meta‐epidemiological studies. Health Technology Assessment 2012;16(35):1‐82. [PUBMED: 22989478] - PubMed
Sayampanathan 2017
    1. Sayampanathan AA, Andrew TH. Systematic review on risk factors of rotator cuff tears. Journal of Orthopaedic Surgery (Hong Kong) 2017;25(1):2309499016684318. [PUBMED: 28211286] - PubMed
Schünemann 2011a
    1. Schünemann HJ, Oxman AD, Higgins JP, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and 'Summary of findings' tables.In Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Schünemann 2011b
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, Guyatt GH. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from: www.cochrane‐handbook.org.
Seida 2010
    1. Seida JC, LeBlanc C, Schouten JR, Mousavi SS, Hartling L, Vandermeer B, et al. Systematic review: non‐operative and operative treatments for rotator cuff tears. Annals of Internal Medicine 2010;153(4):246‐55. - PubMed
Shields 2015
    1. Shields E, Thirukumaran C, Thorsness R, Noyes K, Voloshin I. An analysis of adult patient risk factors and complications within 30 days after arthroscopic shoulder surgery. Arthroscopy : the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2015;31(5):807‐15. [PUBMED: 25661861] - PubMed
Song 2016
    1. Song L, Miao L, Zhang P, Wang WL. Does concomitant acromioplasty facilitate arthroscopic repair of full‐thickness rotator cuff tears? A meta‐analysis with trial sequential analysis of randomized controlled trials. SpringerPlus 2016;5(1):685. [PUBMED: 27350920] - PMC - PubMed
Sterne 2011
    1. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta‐analyses of randomised controlled trials. BMJ (Clinical research ed.) 2011;343:d4002. [PUBMED: 21784880] - PubMed
Tashjian 2009
    1. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. Journal of Shoulder and Elbow Surgery 2009;18(6):927‐32. - PubMed
Teunis 2014
    1. Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. Journal of Shoulder and Elbow Surgery 2014;23(12):1913‐21. [PUBMED: 25441568] - PubMed
van der Meijden 2012
    1. Meijden OA, Westgard P, Chandler Z, Gaskill TR, Kokmeyer D, Millett PJ. Rehabilitation after arthroscopic rotator cuff repair: current concepts review and evidence‐based guidelines. International Journal of Sports Physical Therapy 2012;7(2):197‐218. - PMC - PubMed
Vecchio 1995
    1. Vecchio P, Kavanagh R, Hazleman BL, King RH. Shoulder pain in a community‐based rheumatology clinic. British Journal of Rheumatology 1995;34:766‐9. - PubMed
Wood 2008
    1. Wood L, Egger M, Gluud LL, Schulz KF, Juni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta‐epidemiological study. BMJ (Clinical research ed.) 2008;336(7644):601‐5. [PUBMED: 18316340] - PMC - PubMed
Yamaguchi 2000
    1. Yamaguchi K, Sher JS, Andersen WK, Garretson R, Uribe JW, Hechtman K, et al. Glenohumeral motion in patients with rotator cuff tears: a comparison of asymptomatic and symptomatic shoulders. Journal of Shoulder and Elbow Surgery 2000;9(1):6‐11. [PUBMED: 10717855] - PubMed
Yamaguchi 2001
    1. Yamaguchi K, Tetro A, Blam O, Evanoff B, Teefey S, Middleton W. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. Journal of Shoulder and Elbow Surgery 2001;10:199‐203. - PubMed
Yamaguchi 2006
    1. Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. Journal of Bone and Joint surgery. American volume 2006;88(8):1699‐704. [PUBMED: 16882890] - PubMed
Yian 2005
    1. Yian EH, Ramappa AJ, Arneberg O, Gerber C. The Constant score in normal shoulders. Journal of Shoulder and Elbow Surgery 2005;14(2):128‐33. [PUBMED: 15789004] - PubMed
Östor 2005
    1. Ostor AJ, Richards CA, Prevost AT, Speed CA, Hazleman BL. Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology (Oxford, England) 2005;44(6):800‐5. [PUBMED: 15769790] - PubMed

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