| Timing of Surgical Intervention: Evidence is too limited to draw conclusions about the comparative effectiveness of early surgical repair when compared to late surgical repair following nonoperative interventions. |
| Operative vs. Nonoperative Interventions*: Significant improvements were seen in all study groups regardless of the intervention. Although there was a trend for better outcomes with surgery, results were too limited to permit conclusions. |
| Nonoperative Interventions†: The variety of interventions and the low quality of studies precludes any conclusions about the most effective nonoperative patient-management strategy. |
| Operative
Interventions: Functional outcomes were similar for open vs. mini-open repair; mini-open vs. arthroscopic repair; open or mini-open vs. arthroscopic repair; and arthroscopic repair with or without acromioplasty (  ). However,
exceptions were:
|
| Postoperative Rehabilitation‡: Overall, patients improved over the course of postoperative followup. However, there was not enough quality evidence to determine the optimal postoperative rehabilitation protocol. |
| Adverse Events: In general, complication rates were low for clinically important complications such as retears, stiffness, infection, and neurological injury. |
Nonoperative comparators included shock-wave therapy, steroid injection, physical therapy, modified activity, oral medication, passive stretching, and strengthening. Operative interventions included mini-open, open, arthroscopic debridement, or open repair with acromioplasty.
Nonoperative interventions included stretching and strengthening, steroid injections, and oral medications.
Postoperative rehabilitation interventions usually included an unspecified physical therapy component; however, the comparisons varied across studies.
From: Comparative Effectiveness of Interventions for Rotator Cuff Tears in Adults
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