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Seida JC, Schouten JR, Mousavi SS, et al. Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2010 Jul. (Comparative Effectiveness Reviews, No. 22.)
This publication is provided for historical reference only and the information may be out of date.
Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears [Internet].
Show details| Study | Study design | Participant characteristics | Treatment characteristics | Outcomes reported | Author conclusions |
|---|---|---|---|---|---|
| Audenaert E, 2006 Country: Belgium Treatment category: Operative Questions: Q2, Q5 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: Dec 1996 to Aug 2002 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 43 mo (24–86 mo) Inclusion criteria: Pre-op ultrasonographic evidence of a primary mass FT-RC tear ≥ 2 tendons measuring > 4 cm (max) thought to be irreparable by simple suture Exclusion criteria: Revision repairs | Enrolled: 41 Analyzed: 39 Withdrawals: 2 Duration since symptom onset, mean (range): 11.5 mo (3 mo–4.5 yr) Type of tear: FTT Tendon(s) torn: SS+IS, SS+IS+SC, SS+SC GROUP 1 N: 41 Age, mean±SD (range): 67 yr (51–80 yr) Males %: 56.1 Cause of tear: degenerative (23), traumatic (16) Tear size: lg Dominant shoulder %: 63.4 Comorbidities: partially torn biceps tendon | GROUP 1 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenodesis (4) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: • acromiohumeral interval • mesh thickness • cuff integrity | Synthetic grafts for massive RC tendon defect combined with subacromial decompression can give significant pain relief and improvement of ROM and strength with few complications for short term periods. |
| Baker CL, 1995 Country: USA Treatment category: Operative approach Questions: Q2, Q5, Q6 Funding: No funding | Recruitment dates: Jan 1987 to Jan 1990 Study design: retrospective cohort Enrolled consecutively: NR Followup duration, (minimum): 2 yr Inclusion criteria: (1) chronic RC tear + pain, weakness, disability not improved by nonoperative tx >3mo, (2) FTT, (3) RC tear ≤5 cm that had been repaired, (4) follow up ≥ 2 yr, (5) surgical procedure: open RCR, acromioplasty/mini-open RCR and subacromial decompression Exclusion criteria: Mass tears | Enrolled: 36 (shld: 37) Analyzed: 36 (shld: 37) Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 20 (shld: 20) Age, mean±SD (range): 62 yr. (38–81 yr.) Males %: 60 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: 50 Comorbidities: NR GROUP 2 N: 16 (shld: 17) Age, mean±SD (range): 59 yr. (41–71 yr.) Males %: 56.3 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: 81.3 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (day 1–wk 3); active-assisted stretching (wk. 3–6 or 8); strengthening (wk 6–8) Rehab regime: NR GROUP 2 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): none Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (day 1–wk 3); active-assisted stretching (wk 3–6 or 8); strengthening (wk 6–8) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: NR | HRQL: NR Function: • UCLA Pain: • VAS ROM: • flexion • abduction • external rotation Strength: • flexion • abduction • external rotation Other: • time to return to work • days of hospitalization • cuff integrity | Arthroscopically assisted RCR is as effective as open repair in the surgical tx of symptomatic complete RC tears. |
| Baysal D, 2005 Country: Canada Treatment category: Operative Questions: Q2 Funding: NR BA Quality: Consecutive: U Followup: N Outcome assessment: Y | Recruitment dates: Apr 1997 to Jul 2000 Study design: before-and-after Enrolled consecutively: NR Followup duration, mean (endpoint): 1–5 yr Inclusion criteria: Symptomatic FTT confirmed by MRI or arthrogram Exclusion criteria: (1) previous surgery of affected shld, (2) PTT, (3) SC involvement, (4) Bankart lesions or severe glenohumeral OA | Enrolled: 84 Analyzed: 60 Withdrawals: 24 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, SS+IS+TM GROUP 1 N: 84 Age, mean±SD (range): 53.2±9.9 yr (22–82 yr) Males %: 72.6 Cause of tear: NR Tear size: all sizes Dominant shoulder %: NR Comorbidities: biceps, labral and/or articular abnormalities in addition to tears (35) | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (all); SLAP repair (NR); biceps tenotomy/tenodesis (NR) Duration of immobilization: 6 wk. Duration of rehab: 26 wk Rehab components: passive/active-assisted stretching (wk 1–6); active stretching and strengthening (wk 6–10); strengthening and therapist-assisted joint mobilization (wk 10–26) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: • WORC Index Function: • ASES Pain: NR ROM: • flexion (standing) • flexion (supine) • external rotation (arm at side) • external rotation (arm abducted) Strength: NR Other: • return to work status • satisfaction | Mini-open RCR led to improved shoulder function and health related quality of life up to 5 yr post surgery. |
| Bennett WF, 2003 Country: USA Treatment category: Operative Questions: Q2 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: 1997 to 1999 Study design: prospective cohort treated as before-and-after Enrolled consecutively: yes Followup duration, mean (range): 3.2 yr (2–4 yr) Inclusion criteria: Mass RC tear Exclusion criteria: (1) stage 4 fatty degeneration, (2) loss of passive ROM, (3) arthroscope identified intra-articular lesion, (4) RC tear + stiff shld, (5) cartilage damage; (6) SLAP lesion, (7) concomitant Bankart lesion, (8) labral tear | Enrolled: 37 Analyzed: 37 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 29 Age, mean±SD (range): 68.2 yr (NR) Males %: 58.6 Cause of tear: NR Tear size: mass Dominant shoulder %: 86.2 Comorbidities: NR GROUP 2 N: 8 Age, mean±SD (range): 63 yr (NR) Males %: 75 Cause of tear: NR Tear size: mass Dominant shoulder %: 100 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): inferolateral coracoplasty Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching (wk 3); strengthening (wk 6) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures: inferolateral coracoplasty Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching (wk 3); strengthening (wk 6) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES • percent function • CMS Pain: • VAS ROM: NR Strength: NR Other: • satisfaction | The arthroscopic RCR of massive RC tear is effective for decreasing pain and improving the functional status of the shld for most patients. |
| Bennett WF, 2003 Country: USA Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: 1997 to 1999 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): NR (2–4 yr.) Inclusion criteria: (1) FTT with involvement of the SS tendon alone, (2) positive Jobe test Exclusion criteria: (1) RC tear with involvement of the SC, IS or either of the medial or lateral heads of the coracohumeral ligament; (2) PTT; (3) pts with FTT and loss of passive ROM or an intra-articular lesion | Enrolled: 24 Analyzed: 24 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS GROUP 1 N: 24 Age, mean±SD (range): 59.9 yr. (NR) Males %: 58.3 Cause of tear: NR Tear size: sm, med Dominant shoulder %: 79.2 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (NR) Duration of immobilization: 6 wk. Duration of rehab: NR Rehab components: passive stretching–wk. 1–6; strengthening–wk. 6; active-assisted stretching–wk. 6; active stretching–wk. 9; Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo. (min) Type of treatment: physical therapy NOS; cortisone injection; NSAID | HRQL: NR Function: • CMS • ASES Pain: • VAS ROM: NR Strength: NR Other: • percent function | Arthroscopic RCR is effective for improving the functional status of the shoulder. |
| Bennett WF, 2003 Country: USA Treatment category: Operative technique Questions: Q2, Q5, Q6 Funding: NR NOS: 4*/8* | Recruitment dates: 1995 to 1999 Study design: prospective cohort Enrolled consecutively: NR Followup duration, mean (range): NR (2–4 yr) Inclusion criteria: (1) PTT and FTT of SC tendon, (2) FTT of SS lesion Exclusion criteria: (1) involvement of any other tendon of the RC, (2) PTT of SS tendon, (3) auto accidents, (4) pts with an intra-articular lesion | Enrolled: 35 Analyzed: 19 Withdrawals: 16 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, SC GROUP 1 N: 9 Age, mean±SD (range): 58 yr (NR) Males %: 55.6 Cause of tear: NR Tear size: NR Dominant shoulder %: 100 Comorbidities: biceps pathology (total from both groups: 18) GROUP 2 N: 10 Age, mean±SD (range): 64 yr (NR) Males %: 70 Cause of tear: NR Tear size: NR Dominant shoulder %: 100 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): NR Technique: bioabsorbable tacs Duration of immobilization: 3 wk (daytime); 6 wk (nighttime) Duration of rehab: NR Rehab components: passive stretching (wk 6); active-assisted stretching (≥wk 6 wk; strengthening (≥wk 6); active stretching (≥wk 9) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): biceps tenotomy/tenodesis (NR) Technique: routine suture tying with metal corkscrew Duration of immobilization: 4 wk (daytime); 6 wk (nighttime) Duration of rehab: NR Rehab components: passive stretching (wk 6); active-assisted stretching (≥wk 6); strengthening (≥wk 6); active stretching (≥wk 9) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • ASES • percent function Pain: • VAS ROM: NR Strength: NR Other: NR | Arthroscopic repair of anterosuperior RC tear provides improvement in function, decreases in pain, decreases in clinical findings of biceps subluxation and inflammation, improvement in shoulder scores, and increased clinical findings of subscapularis insufficiency. |
| Bigoni M, 2009 Country: Italy Treatment category: Operative technique Questions: Q2, Q6 Funding: NR ROB: High | Recruitment dates: Sept 2004 to Sept 2006 Study design: RCT (parallel) Enrolled consecutively: yes Followup duration, mean (range): 12 mo Inclusion criteria: (1) age 50–65 year, (2) FTT of SS with an intact SC, (3) healthy contralateral shoulder, (4) concomitant pathology of LHB Exclusion criteria: (1) PTT, (2) mass RC tears, (3) previous surgery on affected shoulder, (4) degenerative OA of glenohumeral joint, (5) neurologic pathology, (6) cervical slipped disk, (7) WCB, (8) disease of opposite shoulder | Enrolled: 50 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS GROUP 1 N: 25 Age, mean±SD (range): NR Males %: 40 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: 84 Comorbidities: NR GROUP 2 N: 25 Age, mean±SD (range): NR Males %: 56 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: 88 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): NR Technique: side-to-side repair & permanent sutures Duration of immobilization: NR Duration of rehab: >6 mo Rehab components: neutral rotation in sling (day 1–wk 4); passive stretching with pool therapy (≥wk 3); active-assisted stretching (≥wk 6); isometric, isotonic & isokinetic training after full ROM Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): NR Technique: tendon-to-bone fixation & metal suture anchors (double sutures) Duration of immobilization: NR Duration of rehab: >6 mo Rehab components: neutral rotation in sling (day 1–wk 4); passive stretching with pool therapy (≥wk 3); active-assisted stretching (≥wk 6); isometric, isotonic & isokinetic training after full ROM Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: • IR peak torque % • ER peak torque % | There was a significant difference in strength between the groups, favouring the tendon-to-bone over the side-to-side technique for arthroscopic repairs. |
| Bishop J, 2006 Country: USA Treatment category: Operative approach Questions: Q2, Q6 Funding: Government, foundation NOS: 5*/8* | Recruitment dates: 1996 to 2002 Study design: Prospective cohort Enrolled consecutively: yes Followup duration, (endpoint): 1 yr Inclusion criteria: FTT confirmed by MRI Exclusion criteria: (1) glenohumeral arthritis, (2) fracture, (3) osteonecrosis labral pathology; 4) unable/unwilling to undergo MRI | Enrolled: 102 Analyzed: 72 Withdrawals: 30 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 47 Age, mean±SD (range): 64 yr (NR) Males %: NR Cause of tear: NR Tear size: sm, med, lg, mass (mean: 2.6 cm) Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 55 Age, mean±SD (range): 64 yr (NR) Males %: NR Cause of tear: NR Tear size: sm, med, lg, mass (mean: 3.0 cm) Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open (24); mini-open (8) Type of surgery: repair Additional procedures (N): distal clavical resection (4); revision surgery (2); capsular release (all) Duration of immobilization: 6 wk Duration of rehab: 3–4 mo Rehab components: passive stretching (wk 1–6); active stretching (wk ≥6); strengthening (wk 6–12 or 16) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): distal clavicle resection (11); revision (1) Duration of immobilization: 6 wk Duration of rehab: 3–4 mo Rehab components: passive stretching (wk 1–6); active stretching (wk ≥6); strengthening (wk 6–12 or 16) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES • CMS Pain: • VAS ROM: NR Strength: • flexion • external rotation Other: • cuff integrity | Open and arthroscopic RCR have similar clinical outcomes. |
| Boehm TD, 2005 Country: Germany Treatment category: Operative technique Questions: Q2, Q5, Q6 Funding: No funding ROB: High | Recruitment dates: NR Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): Group 1: 27 mo (24–30); Group 2: 26 mo (24–29) Inclusion criteria: (1) repairable, nontraumatic FTT (1–5 cm), (2) suitable for direct tendon-to-bone repair Exclusion criteria: (1) previous shld surgery, (2) presence of os acromiale, (3) neurological deficit in upper limb, (4) cervical disc disease, (5) systemic locomotor disease, (6) metastatic malignancy, (7) >grade 1 glenohumeral OA, (8) SC tear requiring repair, (9) shld instability | Enrolled: 100 Analyzed: 93 Withdrawals: 7 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 50 Age, mean±SD (range): 56 yr (38–69 yr) Males %: 72 Cause of tear: degenerative (44), traumatic (5) Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: rupture of long head biceps (4) GROUP 2 N: 50 Age, mean±SD (range): 57 yr (41–71 yr) Males %: 64 Cause of tear: degenerative (49), traumatic (1) Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: rupture of LHB (2) | GROUP 1 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (9); lateral clavicle resection (40) Suture/anchor type: non- absorbable suture with Mason- Allen technique; side-to-side sutures Duration of immobilization: 6 wk Duration of rehab: 6 wk Rehab components: passive stretching (day 1–wk 6); CPM (day 1–wk 6); active stretching (wk ≥6) Rehab regime: Frequency–passive stretching, 3×/wk.; active stretching 2× daily; Intensity–CPM, 30 min GROUP 2 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (10); lateral clavicle resection (34) Suture/anchor type: absorbable suture with modified Kessler technique; side-to side sutures Duration of immobilization: 6 wk Duration of rehab: 6 wk Rehab components: passive stretching (day 1–wk 6); CPM (day 1–wk 6); active stretching (wk ≥6) Rehab regime: Frequency–passive stretching, 3×/wk; active stretching, 2× daily; Intensity–CPM, 30 min PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: •CMS Pain: NR ROM: NR Strength: NR Other: • pt satisfaction • pt willingness to have the same surgery again • cuff integrity | The advantages of special suture techniques and non- absorbable materials are unproven in the clinical setting in terms of both clinical outcome and rate of recurrence. Absorbable suture material may have advantages in repair of the RC when the quality of the tendon is poor. |
| Boileau P, 2007 Country: France Treatment category: Operative approach Questions: Q2, Q5, Q6 Funding: No funding NOS: 6*/8* | Recruitment dates: Oct 1999 to Feb 2002 Study design: retrospective cohort Enrolled consecutively: yes Followup duration, mean±SD (range): 35±7 mo (24–76 mo) Inclusion criteria: (1) mass, irreparable RC tear; (2) treated with tenotomy or tenodesis Exclusion criteria: (1) concomittant procedure (attempted RCR, acromioplasty, or other); (2) previous surgery | Enrolled: 78 (shld: 82) Analyzed: 68 (shld: 72) Withdrawals: 10 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: shld: 39 Age, mean±SD (range): all groups: 68 yr (52–85 yr) Males %: NR Cause of tear: NR Tear size: mass Dominant shoulder %: 80.8 (all groups) Comorbidities: lesion of LHB (all groups) GROUP 2 N: shld: 33 Age, mean±SD (range): see group 1 Males %: NR Cause of tear: NR Tear size: mass Dominant shoulder %: see group 1 Comorbidities: see group 1 | GROUP 1 Surgical approach: all- arthroscopic Type of surgery: NA Additional procedures (N): biceps tenotomy/tenodesis (39)/(36) Duration of immobilization: 2–3 wk Duration of rehab: NR Rehab components: passive stretching (day 1); strengthening (wk ≥6) Rehab regime: Frequency–5×/day; Intensity–5 min. GROUP 2 Surgical approach: all- arthroscopic Type of surgery: NA Additional procedures (N): biceps tenotomy/tenodesis (39)/(36) Duration of immobilization: 2–3 wk. Duration of rehab: NR Rehab components: passive stretching (day 1); strengthening (wk ≥6) Rehab regime: Frequency–5×/day; Intensity–6 min. PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: • flexion (active) • external rotation (active) • internal rotation • external rotation (passive) • flexion (passive) Strength: NR Other: • number of pts satisfied with procedure • post-op symptoms related to biceps | Both arthroscopic biceps tenotomy and tenodesis can effectively treat severe pain or dysfunction caused by irreparable RC tears associated with biceps lesions. |
| Boileau P, 2005 Country: France Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: May 1999 to Dec 2001 Study design: before- and-after Enrolled consecutively: yes Followup duration, mean (range): 29 mo (24–46 mo) Inclusion criteria: (1) chronic FTT limited to SS tendon, (2) arthroscopic RCR, (3) evaluation of tendon healing and cuff integrity at least 6 mo after surgery, (4) clinical exam ≥2 yr after surgery Exclusion criteria: (1) PTT, (2) partial repair, (3) previous operation on involved cuff | Enrolled: 65 Analyzed: 65 Withdrawals: 0 Duration since symptom onset, mean (range): 2.2 yr (7 mo–20 yr) Type of tear: FTT Tendon(s) torn: SS GROUP 1 N: 65 Age, mean±SD (range): 60 yr (29–79 yr) Males %: 49.2 Cause of tear: degenerative (36), traumatic (29) Tear size: sm, med, lg Dominant shoulder %: 76.9 Comorbidities: biceps pathology (56) | GROUP 1 Surgical approach: all- arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (61); biceps tenotomy/tenodesis (3)/(53); resection of distal clavicle (4) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (day 1–wk 6); CPM (wk 3); hydrotherapy encouraged Rehab regime: Frequency–5×/day; Intensity–5 min PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: physical therapy NOS, cortisone injection, medication NOS | HRQL: NR Function: • CMS • UCLA • SST Pain: NR ROM: NR Strength: NR Other: • cuff integrity | Arthroscopic RCR leads to complete tendon healing. Patients with associated delamination of SC and/or IS and >65 yr have significantly lower healing. |
| Boissonnault WG, 2007 Country: USA Treatment category: Post- op rehabilitation Questions: Q2, Q6 Funding: Professional association BA Quality: Consecutive: U Followup: N Outcome assessment: N | Recruitment dates: May 2002 to Jun 2003 Study design: before- and-after Enrolled consecutively: NR Followup duration, mean±SD (range): 13±5.1 wk (3–28 wk) Inclusion criteria: (1) recent surgical repair of RC tear + outpatient rehab, (2) >45 yr Exclusion criteria: (1) involved in litigation for shld condition, (2) previous shld surgery, (3) concurrent significant shld injuries (fracture or dislocation), (4) worker compensation/permanent disability of shld | Enrolled: 118 Analyzed: 86 Withdrawals: 32 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 118 Age, mean±SD (range): 67±8.6 yr (49–82 yr) Males %: 31.4 Cause of tear: traumatic (86) Tear size: NR Dominant shoulder %: NR Comorbidities: BMI >25; high blood pressure; degenerative OA; asthma; depression; headache; pneumonia; kidney disease; sinus infection | GROUP 1 Surgical approach: open (NR) or all-arthroscopic (NR) Type of surgery: repair Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: 12 wk Rehab components: passive stretching (wk 1–16); active stretching (wk 1–16); active- assisted stretching (wk 2/3–16); strengthening (wk 2/3–16); Modalities as needed for pain; cold; transcutaneous electrical nerve stimulation Rehab regime: Frequency–daily; Intensity–2×/day (home program) PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS | HRQL: • SF-36 Function: • DASH Pain: NR ROM: NR Strength: NR Other: NR | The presence of medical comorbidities should not be considered a negative factor for RCR and subsequent rehabilitation. However, the impact of general health status should be considered by physical therapists for postoperative progression. |
| Boszotta H, 2004 Country: Austria Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: N Followup: Y Outcome assessment: U | Recruitment dates: 1997 to NR Study design: before- and-after Enrolled consecutively: No Followup duration, mean (range): 35 mo (28–44 mo) Inclusion criteria: Failed nonoperative tx Exclusion criteria: NR | Enrolled: 84 Analyzed: 84 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 84 Age, mean±SD (range): 54.8 yr (32–74 yr) Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: biceps pathology (32) | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy (7) Duration of immobilization: 3–4 wk Duration of rehab: NR Rehab components: passive stretching (wk 1–3/4); active stretching (wk ≥4) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3–14 mo (range) Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: • CMS • UCLA Pain: NR ROM: NR Strength: NR Other: NR | Arthroscopically assisted repair of the RC was shown to be an effective procedure with good clinical results for medium and large tears with adequate mobility, including primary stability comparable to that seen with open repair. |
| Brady B, 2008 Country: Australia Treatment category: Post- op rehabilitation Questions: Q2, Q5 Funding: NR ROB: High | Recruitment dates: Nov 2004 to Apr 2005 Study design (trial type): CCT (parallel) Enrolled consecutively: yes Followup duration (endpoint): 12 wk Inclusion criteria: (1) >18 yr, (2) symptoms >3 mo and <12 mo, (3) transportation for appointments, (4) diagnostic evidence of RC tear Exclusion criteria: NR | Enrolled: 18 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 12 Age, mean±SD (range): 56.3±9 yr (41–67 yr) Males %: 66.7 Cause of tear: NR Tear size: sm, med, lg, mass Dominant shoulder %: 50 Comorbidities: NR GROUP 2 N: 6 Age, mean±SD (range): 53.5±16 yr (26–69 yr) Males %: 50 Cause of tear: NR Tear size: sm, med, lg, mass Dominant shoulder %: 66.7 Comorbidities: NR | GROUP 1 Duration of immobilization: NR Duration of rehab: 12 wk Rehab components: passive stretching (wk 1–3); active- assisted stretching (wk 4–6); strengthening (wk 10–12); aquatic therapy (day 10–wk 6 or 10) Rehab regime: Frequency–land, 5×/day; Intensity–land, 10 reps; aqua, 3 sets of 5–10 reps GROUP 2 Duration of immobilization: NR Duration of rehab: 12 wk Rehab components: passive stretching (wk 1–3); active- assisted stretching (wk 4–6); strengthening (wk 10–12) Rehab regime: Frequency–5×/day; Intensity–10 reps PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: • WORC index Function: NR Pain: NR ROM: • flexion • external rotation Strength: NR Other: NR | A combined aquatic and land-based physical therapy program following surgical RCR has comparable outcomes with a conventional land-based program. |
| Buess E, 2005 Country: Switzerland Treatment category: Operative approach Questions: Q2, Q5, Q6 Funding: NR NOS: 6*/8* | Recruitment dates: Mar 1999 to Feb 2001 Study design: prospective cohort Enrolled consecutively: yes Followup duration, mean (range): 24.6 mo (15–40 mo) Inclusion criteria: (1) RCR with bony reattachment, (2) surgery performed by the same surgeon Exclusion criteria: (1) intratendinous sutures, (2) open repair by a different surgeon | Enrolled: 95 (shld: 99) Analyzed: 92 (shld: 96) Withdrawals: 3 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: Group 1: SS and/or IS, SC Group 2: SS and/or IS GROUP 1 N: 29 (shld: 30) Age, mean±SD (range): 48.3 yr (18–73 yr) Males %: 72.4 Cause of tear: degenerative (11), traumatic (18) Tear size: all sizes Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 63 (shld: 66) Age, mean±SD (range): 53.2 yr (20–77 yr) Males %: 69.8 Cause of tear: degenerative (19), traumatic (44) Tear size: all sizes Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open (NR), mini-open (NR) Type of surgery: repair and debridement Additional procedures (N): biceps/tenodesis (9); SLAP repair (1); AC resection (5) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching; active stretching Rehab regime: NR GROUP 2 Surgical approach: all- arthroscopic Type of surgery: repair and debridement Additional procedures (N): biceps tenodesis (10); SLAP repair (19) + AC resection (9) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: active- assisted stretching (wk 1–6) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: physical thearpy NOS | HRQL: NR Function: • SST Pain: • VAS ROM: NR Strength: NR Other: • mean days free of pain • number of pts satisfied | Equal or better results were obtained by arthroscopic RCR than open RCR. Pain decreased and a better functional result concerning mobility in patients with arthroscopic RCR was achieved. Arthroscopic repair is successful for large and small tears. Biomechanically, large tears might benefit more than small tears. |
| Burks RT, 2009 Country: USA Treatment category: Operative technique Questions: Q2, Q5 Funding: Industry ROB: High | Recruitment dates: NR Study design: RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): 12 mo Inclusion criteria: (1) FTT on MRI, (2) complete serial MRIs, (3) willingness to undergo standard RC physical therapy, (4) willingness to be randomized to single- row or double-row repair, (5) repairable tear when evaluated at the time of surgery Exclusion criteria: (1) active hx of smoking, (2) autoimmune or rheumatological disease, (3) active use of steroids, (4) previous RC surgery on the affected shoulder, (5) irrepairable RC tear, (6) WCB, (7) significant SC tear, (8) tear pattern that required a significant side-to-side repair | Enrolled: 40 Analyzed: 40 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, SC Cause of tear: degenerative (15), traumatic (25) GROUP 1 N: 20 Age, mean±SD (range): 57 yr (41–81 yr) Males %: NR Tear size: med, lg Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 20 Age, mean±SD (range): 56 yr (43–74 yr) Males %: NR Tear size: med, lg Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); distal clavicle resection (8); debridement of frayed upper SC (3); biceps tenodesis/tenotomy (total: 7); debridement of SLAP lesion (total: 1) Technique: double-row repair Duration of immobilization: <1 wk Duration of rehab: >6 mo Rehab components: passive stretching (1 wk); active-assisted stretching (4–6 wk); active stretching (6–8 wk); strengthening (10–12 wk) Rehab regime: NR GROUP 2 Surgical approach: all- arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); distal clavicle resection (4); debridement of frayed upper SC (3); biceps tenodesis/tenotomy (total: 7); debridement of SLAP lesion (total: 1) Technique: single-row repair Duration of immobilization: <1 wk Duration of rehab: >6 mo Rehab components: passive stretching (1 wk); active-assisted stretching (4–6 wk); active stretching (6–8 wk); strengthening (10–12 wk) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: • WORC Index Function: • ASES • CMS • Single Assessment Numeric Evaluation • UCLA Pain: NR ROM: NR Strength: • internal rotation • external rotation Other: • Cuff integrity | No clinical or MRI differences were seen between patients repaired with a single-row or double- row technique. |
| Caniggia M, 1995 Country: Italy Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: N Followup: Y Outcome assessment: U | Recruitment dates: NR Study design: before- and-after Enrolled consecutively: No Followup duration, mean (range): 17.5 mo (6–24 mo) Inclusion criteria: (1) <60 yr; (2) no history of DM or decreased heritable connective tissue disorders; (3) no osteopenia, osteoporosis, OA, bony cysts, subacromial sclerosis, acromial spurs Exclusion criteria: NR | Enrolled: 34 Analyzed: 34 Withdrawals: 0 Duration since symptom onset, mean (range): 10.7 mo (1 mo–3 yr) Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 34 Age, mean±SD (range): 41.2 yr (22–56 yr) Males %: 58.8 Cause of tear: traumatic (34) Tear size: all sizes Dominant shoulder %: 85.3 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: sm to lg tears: passive stretching (day 4); active stretching (day 20); mass tears: passive stretching (day 20); active stretching following passtive stretching Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • UCLA Pain: NR ROM: NR Strength: NR Other: NR | The use of titanium anchors shortens postoperative time and UCLA score is comparable with the traditional technique. Titanium anchors should not be used when bone quality is poor or good patient compliance is doubtful. |
| Charousset C, 2008 Country: France Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: N | Recruitment dates: Jan 2001 to Dec 2003 Study design: before- and-after Enrolled consecutively: yes Followup duration (maximum): 2 yr Inclusion criteria: (1) FTT and chronic shld pain, (2) min 6 mo nonoperative tx Exclusion criteria: (1) PTT, (2) shld instability, (3) prior shld surgery, (4) OA, (5) allergy to iodine, (6) total rupture of the SC tendon | Enrolled: 114 Analyzed: 104 Withdrawals: 10 Duration since symptom onset, mean (range): 15.2 mo (1 mo–10.2 yr) Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+SC, SS+IS+SC GROUP 1 N: 114 Age, mean±SD (range): 59.4 yr (32–78 yr) Males %: 46.5 Cause of tear: degenerative (80), traumatic (34) Tear size: NR Dominant shoulder %: 84.2 Comorbidities: degenerative disease (80) | GROUP 1 Surgical approach: all- arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (60)/(2); coplaning of AC joint (18) Duration of immobilization: 6 wk Duration of rehab: 6 mo Rehab components: passive stretching (day 1–wk 6); active stretching (wk 6–3 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: physical therapy NOS, cortisone injection | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: • number of pts satisfied • cuff integrity | Good results in a terms of functional recovery can be achieved by arthroscopic RCR. Female sex, upper- limb heavy work, and poor bone quality are negative prognostic factors. |
| Charousset C, 2007 Country: France Treatment category: Operative technique Questions: Q2, Q5 Funding: NR ROB: High | Recruitment dates: Oct 2001 to Mar 2003 Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): 28.1 mo (24–40 mo) Inclusion criteria: (1) no previous surgery, (2) no sign of adhesive capsulitis or shld instability, (3) complete SS tear Exclusion criteria: (1) irreparable tear, (2) extension of SS tear to more than 1/3 of SC or IS tendon | Enrolled: 66 Analyzed: 61 Withdrawals: 5 Duration since symptom onset, mean (range): Group 1: 14.7 mo (1–73 mo); Group 2: 11.9 mo (1–52 mo) Type of tear: NR Tendon(s) torn: IS, SC, SS GROUP 1 N: 31 Age, mean±SD (range): 60 yr (37–62 yr) Males %: 51.6 Cause of tear: degenerative (22), traumatic (9) Tear size: NR Dominant shoulder %: 74.2 Comorbidities: NR GROUP 2 N: 35 Age, mean±SD (range): 58 yr (32–74 yr) Males %: 42.9 Cause of tear: degenerative (26), traumatic (9) Tear size: NR Dominant shoulder %: 77.1 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy (9) Technique: double-row anchor; side-to-side suture Duration of immobilization: 5 wk Duration of rehab: NR Rehab components: passive stretching (day 1–5 wk); active stretching (wk ≥6) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy (5) Technique: single-row anchor; side- to-side suture Duration of immobilization: 5wk. Duration of rehab: NR Rehab components: passive stretching (day 1–wk 6); active stretching (wk ≥6) Rehab regime: NR PRE-OP TREATMENT: yes Duration: ≥6 mo (min) Type of treatment: physical therapy NOS; infiltrations, medication NOS | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: • time to return to work • number of pts back to work • cuff integrity | No significant difference in clinical results, but tendon healing rates were better with the double-row anchorage. Improvements in the double-row technique might lead to better clinical and tendon healing results. |
| Checchia SL, 2005 Country: Brazil Treatment category: Operative Questions: Q2, Q5 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: U | Recruitment dates: NR Study design: before- and-after Enrolled consecutively: NR Followup duration, mean (range): 2.7 yr (20 mo–5.6 mo) Inclusion criteria: 1) RC tear associated with severe biceps tendon lesions Exclusion criteria: 1) self-adherent rupture (no mobility of the biceps tendon) | Enrolled: 15 Analyzed: 15 Withdrawals: 0 Duration since symptom onset, mean (range): NR (7 mo.) Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+IS+SC, SS+SC GROUP 1 N: 15 Age, mean±SD (range): 62 yr (41–80 yr) Males %: 60 Cause of tear: NR Tear size: NR Dominant shoulder %: 100 Comorbidities: SLAP lesion (1); biceps tendon: dislocation (6); subluxated (2); severe incomplete tear (7) | GROUP 1 Surgical approach: all- arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); labral repair (1); biceps tenodesis (all); resection of distal clavicle (10) Duration of immobilization: 4–6 wk Duration of rehab: NR Rehab components: passive stretching (wk ≥6); active stretching (wk 6–8+) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: NR Pain: NR ROM: • flexion • external rotation • internal rotation Strength: NR Other: NR | The suture involving the RC and the biceps tendon was effective to correct both lesions. |
| Cofield RH, 2001 Country: USA Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: Jan 1975 to Dec 1983 Study design: before- and-after Enrolled consecutively: yes Followup duration, mean (range): 13.4 yr (2–22 yr) Inclusion criteria: (1) ≥2 yr post operative, (2) open surgical repair of chronic FTT Exclusion criteria: NR | Enrolled: 97 (shld: 105) Analyzed: 97 (shld: 105) Withdrawals: 0 Duration since symptom onset, mean (range): 2.5 yr (1 mo–15 yr) Type of tear: FTT Tendon(s) torn: SS, IS, SS+SC, SS+IS+SC, SS+IS GROUP 1 N: 97 (shld: 105) Age, mean±SD (range): 58 yr (38–75 yr) Males %: 74.2 Cause of tear: degenerative (43), traumatic (62) Tear size: all sizes Dominant shoulder %: NR Comorbidities: mild glenohumeral arthritis (3); biceps pathology (44) | GROUP 1 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (3) Duration of immobilization: 4–6 wk. Duration of rehab: NR Rehab components: passive stretching (day 2–wk 4/6); active- assisted stretching and strengthening (wk 4/6); strengthening (≥3 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: injections (mean/range): 2 (1–15) Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: NR Pain: NR ROM: • abduction (active) • internal rotation • external rotation Strength: • abduction • flexion • external roation Other: • number pts return to work, sports | Standard tendon repair techniques combined with anterior acromioplasty, posterior operative limb protection, and monitored physical therapy can produce consistent and lasting relief and improvement in ROM. |
| Cole BJ, 2007 Country: USA Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: 2001 to 2004 Study design: before- and-after Enrolled consecutively: yes Followup duration, mean (range): 2.7 yr (2–3.8 yr) Inclusion criteria: Symptomatic FTT Exclusion criteria: (1) prior shld surgery; (2) ongoing litigation; (3) ipsilateral greater tuberosity or clavicle fracture; (4) adhesive capulitis contaminant tear in the labrum; (5) SC, TM tear | Enrolled: NR (shld: 55) Analyzed: 47 (shld: 49) Withdrawals: 6 shld Duration since symptom onset, mean (range): 17 mo (2 mo–16.4 yr) Type of tear: FTT Tendon(s) torn: SS, SS+IS GROUP 1 N: 47 (shld: 49) Age, mean±SD (range): 57 yr (34–80 yr) Males %: 59.6 Cause of tear: NR Tear size: all sizes Dominant shoulder %: 74.5 Comorbidities: biceps pathology (23) | GROUP 1 Surgical approach: all- arthroscopic Type of surgery: repair Additional procedures (N): biceps tenotomy/tenodesis (4)/(19) Duration of immobilization: 4 wk Duration of rehab: 4–6 mo Rehab components: passive stretching (day 1–wk 4); active- assisted stretching (wk 4–6); strengthening (wk 6–12) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • SST • ASES • Rowe test • SF-12 Pain: • VAS ROM: • flexion • external rotation • abduction Strength: • flexion • external rotation Other: • cuff integrity | All outcomes improved after a short term followup after arthroscopic RCR. Significant differences were present in age, active ROM, and strength between intact and retear group. |
| Colegate-Stone T, 2009 Country: UK Treatment category: Operative approach Questions: Q2 Funding: NR NOS: 4*/8* | Recruitment dates: 2003–2006 Study design: Prospective cohort Enrolled consecutively: yes Followup duration, mean (range): 24 mo Inclusion criteria: (1) RC repair Exclusion criteria: (1) other significant glenohumeral pathology | Enrolled: 123 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 31 Age, mean±SD (range): 62 yr Males %: 52 Cause of tear: NR Tear size: sm, med Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 92 Age, mean±SD (range): 57 yr Males %: 36 Cause of tear: NR Tear size: sm, med Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): NR Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 2 Surgical approach: all- arthroscopic Type of surgery: repair Additional procedures (N): NR Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • DASH • OSS Pain: NR ROM: NR Strength: NR Other: NR | Arthroscopic RCR is comparable with the mini- open repair with well correlated postoperative recovery rates. |
| Cools A, 2006 Country: Belgium Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: Y | Recruitment dates: NR Study design: prospective cohort treated as before-and- after Enrolled consecutively: NR Followup duration, mean (range): 18 mo (12–20 mo) Inclusion criteria: Group 1: FTT repaired in the same hospital by the same surgeon Group 2: healthy participants Exclusion criteria: (1) prior surgery to the shld, (2) neurologic pathology | Enrolled: 53 Analyzed: 53 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 24 Age, mean±SD (range): 57.2±9.8 yr Males %: 45.8 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: all groups: 79.2 Comorbidities: NR GROUP 2 N: 29 Age, mean±SD (range): 56.4±9.8 yr (NR) Males %: 44.8 Cause of tear: NR Tear size: NR Dominant shoulder %: see group 1 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: >12 wk Rehab components: strengthening (wk 1–12) Rehab regime: NR GROUP 2 Surgical approach: none Type of surgery: NA Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: • internal rotation 60°/sec and 180°/sec • external rotation 60°/sec and 180°/sec Other: NR | Shoulder function is not completely normalised, although significant strength gains are present 18 mo after RCR. |
| Costouros JG, 2006 Country: NR Treatment category: Operative approach Questions: Q2 Funding: NR NOS: 5*/8* | Recruitment dates: NR Study design: Retrospective cohort Enrolled consecutively: NR Followup duration, mean (range): G1: 24 mo (12 mo–4 yr) G2: 18 mo (12 mo–3.5 yr) Inclusion criteria: (1) isolated FTT of SS Exclusion criteria: NR | Enrolled: 37 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS GROUP 1 N: 19 Age, mean±SD (range): 57 yr (40–75 yr) Males %: 74 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 18 Age, mean±SD (range): 54 yr (34–65 yr) Males %: 67 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open RCR Type of surgery: repair Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 2 Surgical approach: all- arthroscopic Type of surgery: repair Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: • fatty infiltration | Isolated SS FTT can be treated with open or arthroscopic repair but open repair is associated with increased progression of fatty degeneration. |
| Cummins CA, 2003 Country: USA Treatment category: Operative technique Questions: Q2, Q5 Funding: NR NOS: 5*/8* | Recruitment dates: Sept 1999 to May 2000 Study design: Prospective cohort Enrolled consecutively: yes Followup duration (endpoint): 1 yr Inclusion criteria: (1) RC tear <4cm2, (2) involved only SS Exclusion criteria: NR | Enrolled: 27 Analyzed: 27 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: SS GROUP 1 N: 18 Age, mean±SD (range): 63±8 yr (NR) Males %: 66.7 Cause of tear: NR Tear size: mean: 1.9 cm2 Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 9 Age, mean±SD (range): 58±10 yr (NR) Males %: 77.8 Cause of tear: NR Tear size: mean: 1.1 cm2 Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Technique: Mitek metal RC suture anchors; mattress stitch configuration Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 2 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Technique: headed bio- corkscrews Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • Shoulder overall function rating Pain: NR ROM: • abduction Strength: NR Other: NR | Found poorer early outcomes and a lower shoulder function score 1 yr after repair, and a higher rate of repeat surgery in repair with a bioabsorbable screw than with a standard metal suture anchors. |
| Davidson PA, 2000 Country: USA Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: Y Followup: U Outcome assessment: U | Recruitment dates: NR Study design: before- and-after Enrolled consecutively: yes Followup duration (minimum): 24 mo Inclusion criteria: FTT Exclusion criteria: NR | Enrolled: 63 (shld: 67) Analyzed: 63 (shld: 67) Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 63 (shld: 67) Age, mean±SD (range): 62.5 yr (41–83 yr) Males %: 61.9 Cause of tear: NR Tear size: mean: 6.6 cm2; range: 0.6–25 cm2 Dominant shoulder %: 63.5 Comorbidities: NR | GROUP 1 Surgical approach: lg/mass tears: open; sm/med tears: all- arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty–open (30), all- arthroscopic (42); distal clavicle resection (13) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: •CMS Pain: NR ROM: NR Strength: NR Other: NR | Increased tension repairs are associated with poor functional outcomes. |
| De Carli A, 2006 Country: Italy Treatment category: Nonoperative vs. operative Questions: Q4 Funding: Industry ROB: High | Recruitment dates: Oct 2001 to Mar 2004 Study design: RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): G1: 19 mo (12 mo–2.2 yr); G2: 24 mo (12 mo–3 yr) Inclusion criteria: (1) complete RCT Exclusion criteria: NR | Enrolled: 30 Analyzed: NR Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 20 Age, mean±SD (range): 56 yr (43–74) yr Males %: NR Cause of tear: NR Tear size: med, lg Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 20 Age, mean±SD (range): 57 yr (41–81 yr) Males %: NR Cause of tear: NR Tear size: med, lg Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 2 Intervention: electromagnetic shock wave therapy Drug name: NR Duration of treatment: NR Treatment Regime: NR Degree of supervision: NR Treatment provider: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES •CMS •UCLA Pain: NR ROM: NR Strength: NR Other: NR | Surgical tx shows better overall results for strength and function than ESWT. |
| DeFranco MJ, 2007 Country: USA Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: N | Recruitment dates: May 2000 to Mar 2003 Study design: before- and-after Enrolled consecutively: yes Followup duration, mean (range): 22.3 mo (12 mo–3 yr) Inclusion criteria: (1) isolated SS tear, (2) failure of nonoperative tx Exclusion criteria: (1) previous shld surgery, (2) instability, (3) symptomatic AC joint pathology, (4) glenohumeral OA, (5) active infection, (6) stiffness | Enrolled: 30 Analyzed: 30 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT (22); PTT (8) Tendon(s) torn: SS GROUP 1 N: 30 Age, mean±SD (range): 56.3±12.3 yr (30–78 yr) Males %: 63.3 Cause of tear: NR Tear size: sm, med, mean: 2.3 cm Dominant shoulder %: NR Comorbidities: biceps pathology (4), SLAP lesion (3), immobile mesoacromiale (1), coronary artery disease/heart attack/cerebrovascular disease or a stroke/congestive heart failure/peripheral vascular disease/dementia/chronic obstructive pulmonary disease/connective tissue disease | GROUP 1 Surgical approach: all- arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (29); biceps tenotomy/tenodesis (4) Duration of immobilization: NR Duration of rehab: 6 mo Rehab components: passive stretching (day 1–wk 6); active stretching and strengthening (wk 6–6 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: NR | HRQL: • SF-36 Function: • PENN Pain: NR ROM: NR Strength: NR Other: • actual physical activity • cuff integrity | Confirmed that RC integrity and functional outcomes after repair of small and medium sized SS tendon tear are improved by single- row arthroscopic repair. |
| Delbrouck C, 2003 Country: France Treatment category: Post- op rehabilitation Questions: Q2, Q5, Q6 Funding: NR NOS: 2*/8* | Recruitment dates: NR Study design: Prospective cohort Enrolled consecutively: NR Followup duration (endpoint): 60 days Inclusion criteria: (1) RC tear due to overuse, (2) surgical RCR by simple suture or “systeme d’ancrape” Exclusion criteria: (1) non-operated RC tear, (2) isolated acromioplasty, (3) isolated ruptures of SC, (4) tendon transfers or deltoid flaps, (5) retractable capsularis preoperative, (6) previous shld surgry, (7) associated surgical procedures (prosthesis Rx for instability), (8) RC tear associated with fractures | Enrolled: 79 (shld: 84) Analyzed: 71 (shld: 76) Withdrawals: 8 Duration since symptom onset, mean (range): NR Type of tear: FTT (71) PTT (13) Tendon(s) torn: NR GROUP 1 N: shld: 53 Age, mean±SD (range): 52.7±8 yr (NR) Males %: 47.2 Cause of tear: Degenerative (53) Tear size: all sizes Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: shld: 23 Age, mean±SD (range): 55±5 yr (NR) Males %: 69.6 Cause of tear: degenerative (23) Tear size: all sizes Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open (20); mini- open (12); all-arthroscopic (21) Type of surgery: repair Additional procedures (N): acromioplasty (53); labral repair (NR); biceps tenotomy/tenodesis (23); manipulation (NR); clavicle resection, coracoplasty (NR) Duration of immobilization: mean 22.8–29.6 days Duration of rehab: NR Rehab components: passive stretching; active-assisted stretching (23.2±6 day); Modality–pool Rehab regime: Frequency–2×/day, 5×/wk; Intensity–NR GROUP 2 Surgical approach: open (14); mini- open (7); all-arthroscopic (2) Type of surgery: repair Additional procedures (N): acromioplasty (23); lalbral repair (NR); biceps tenotomy/tenodesis (16); manipulation (NR) Duration of immobilization: mean 22.8–29.6 days Duration of rehab: NR Rehab components: passive stretching; active-assisted stretching (23.2±6 day); Modality pool Rehab regime: Frequency–2×/day, 5×/wk; Intensity—NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: NR Pain: • VAS ROM: • abduction • flexion • external rotation Strength: NR Other: NR | Equivalent results were achieved for post operative rehab in hospital compared to day patients. Choice of setting should be made based on other considerations such as social context or patients family needs. |
| Deutsch A, 2008 Country: USA Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: NR Study design: prospective cohort treated as before-and- after Enrolled consecutively: yes Followup duration, mean (range): 3.2 yr (2–5 yr) Inclusion criteria: FTT involved at least the full width of the SS tendon insertion Exclusion criteria: (1) mass tears, (2) previous shld surgery, (3) glenohumeral OA, (4) adhesive capsulitis, (5) osacromidale requiring stabilization | Enrolled: 48 Analyzed: 39 Withdrawals: 9 Duration since symptom onset, mean (range): Group 1: 15 mo (3 mo–5 yr) Group 2: 11 mo (1 mo–5 yr) Total: 15 mo (1 mo–5 yr) Type of tear: FTT Tendon(s) torn: Group 1: SS Group 2: SS, IS, SS GROUP 1 N: 21 Age, mean±SD (range): 54±9.7 yr (32–71 yr) Males %: 71.4 Cause of tear: NR Tear size: mean: 2.0 cm; range:1.8–2.2 cm Dominant shoulder %: 77 (all) Comorbidities: NR GROUP 2 N: 18 Age, mean±SD (range): 51.8±8.6 yr (34–67 yr) Males %: 61.1 Cause of tear: NR Tear size: mean: 3.1 cm; range: 2.5–4.0 cm Dominant shoulder %: see group 1 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (2); biceps debridement (2) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching–post operative; strengthening (wk 6) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (1)/(4); biceps debridement (3) Duration of immobilization: 6 wk. Duration of rehab: NR Rehab components: passive stretching–post operative; strengthening (wk 8) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: • ASES Pain: • VAS ROM: • forward flexion • external rotation • internal rotation Strength: NR Other: • satisfaction • cuff integrity | Arthroscopic RCR using single-row fixation resulted in significant improvements in clinical outcomes and reliable repair integrity for both single tendon and two tendon tears. |
| Deutsch A, 2007 Country: USA Treatment category: Operative Questions: Q2, Q5 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: NR Study design: before- and-after Enrolled consecutively: yes Followup duration, mean (range): 3.2 yr (2–4.2 yr) Inclusion criteria: Arthroscopic repair for PTT of SS that involved >50% of tendon thickness Exclusion criteria: (1) previous surgery, (2) adhesive capsulitis, (3) concomitant glenohumeral instability | Enrolled: 46 Analyzed: 41 Withdrawals: 5 Duration since symptom onset, mean (range): Group 1: 10 mo (6 mo–3 yr) Type of tear: PTT Tendon(s) torn: SS GROUP 1 N: 46 Age, mean±SD (range): 49 yr (23–70 yr) Males %: 56.5 Cause of tear: degenerative (29), traumatic (12) Tear size: mean: 0.9 cm Dominant shoulder %: 54.3 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (39); SLAP repair (5); biceps tenodesis (3); AC joint resection (18) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (day 1–wk 6); active stretching and strengthening (wk 6–3 mo); strengthening (abduction, flexion) (3–6 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: • ASES Pain: • VAS ROM: • flexion • internal rotation • external rotation Strength: • strength Other: NR | Arthroscopic RCR resulted in excellent pain relief, strength, ROM, return of shoulder function and a high degree of pt satisfaction. |
| Ellman H, 1993 Country: USA Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: N Followup: Y Outcome assessment: N | Recruitment dates: Nov 1983 to Jul 1989 Study design: prospective cohort treated as before- and-after Enrolled consecutively: No Followup duration, mean (range): 3.6 yr (2–7.3 yr) Inclusion criteria: FTT Exclusion criteria: Pts not ideal for arthroscopic subacromial decompression as determined by investigator | Enrolled: 80 Analyzed: 80 Withdrawals: 0 Duration since symptom onset, mean (range): Group 1: 4.5 yr (NR) Group 2: 16.8 yr (NR) Group 3: 3.7 yr (NR) Group 4: 5.2 yr (NR) Type of tear: FTT Tendon(s) torn: SS, IS GROUP 1 N: 40 Age, mean±SD (range): 67.9 yr (41–89 yr) Males %: 60 Cause of tear: NR Tear size: all sizes Dominant shoulder %: 50 Comorbidities: NR GROUP 2 N: 10 Age, mean±SD (range): 63 yr (41–89 yr) Males %: 60 Cause of tear: NR Tear size: sm, med Dominant shoulder %: 60 Comorbidities: NR GROUP 3 N: 8 Age, mean±SD (range): 66.7 yr (41–89 yr) Males %: 87.5 Cause of tear: NR Tear size: med, lg Dominant shoulder %: 50 Comorbidities: NR GROUP 4 N: 22 Age, mean±SD (range): 73.9 yr (41–89 yr) Males %: 50 Cause of tear: NR Tear size: lg, mass Dominant shoulder %: 77.3 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 3 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 4 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • UCLA Pain: NR ROM: • flexion • external rotation Strength: • flexion (grade) • external rotation (grade) Other: NR | Proper patient selection is needed for arthroscopic tx of FTT as it influences outcomes. |
| Favard L, 2009 Country: France Treatment category: Operative approach Questions: Q2, Q5 Funding: No funding NOS: 2*/8* | Recruitment dates: NR Study design: Retrospective cohort Enrolled consecutively: no Followup duration, mean (range): 5.6±3.5 yr Inclusion criteria: (1) <65 years, (2) massive RC tear, (3) minimum 2 year clinical and radiographic followup Exclusion criteria: (1) ≥stage III glenohumeral or acromiohumeral arthritis | Enrolled: 192 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 103 Age, mean±SD (range): 55.2±6.2 yr Males %: NR Cause of tear: NR Tear size: mass Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 89 Age, mean±SD (range): 57.1±5.5 yr Males %: NR Cause of tear: NR Tear size: mass Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open (68), all- arthroscopic (34) Type of surgery: repair Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 2 Surgical approach: open (50), all- arthroscopic (39) Type of surgery: repair Additional procedures (N): biceps tenotomy (89) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: NR | In patients younger than 65 years with large or massive tears, the most appropriate surgical treatment option depends on patient functional status, height of subacromial space, fatty muscle infiltration, and presence of the long head of the biceps. |
| Fenlin JM Jr, 2002 Country: USA Treatment category: Operative Questions: Q2, Q5 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: Y | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: NR Followup duration, mean (range): 3.4 yr (7 mo–4.8 yr) Inclusion criteria: Mass, irreparable RC tear with superior humeral head migration Exclusion criteria: (1) glenohumeral arthritis, (2) ability to re-establish functional rotator cable, (3) RC tear arthropathy | Enrolled: 20 Analyzed: 19 Withdrawals: 1 Duration since symptom onset, mean (range): Group 1: 15 mo (2 mo–6 yr) Type of tear: FTT Tendon(s) torn: SS+IS, SS+IS+SC GROUP 1 N: 20 Age, mean±SD (range): 63 yr (44–82 yr) Males %: 75 Cause of tear: degenerative (7), traumatic (12) Tear size: mass Dominant shoulder %: 63.2 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: debidement Additional procedures (N): bursectomy/tuberoplasty (all) Duration of immobilization: NR Duration of rehab: 10–12 mo Rehab components: passive stretching (day 1); strengthening (wk 2/4–10/12 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 wk (min) Type of treatment: physical therapy NOS | HRQL: NR Function: • modified UCLA Pain: NR ROM: NR Strength: NR Other: NR | In the short term, tuberoplasty can provide pain relief and improved function in patients with massive irreparable RC tears. |
| Franceschi F, 2008 Country: UK Treatment category: Operative approach Questions: Q2, Q5 Funding: NR ROB: High | Recruitment dates: Jan 1999 to Dec 2003 Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): 5.2 yr (2.9–7.8 yr) Inclusion criteria: (1) symptoms ≥3 mo, (2) RC tear dx clinically, 3) ≥50 yr, (4) no shld instability, (5) no signs of fracture of glenoid or the greater or lesser tuberoscity, (6) failure of nonoperative tx, (7) RC tear and type II SLAP lesion Exclusion criteria: (1) <50 yr, (2) inflammatory joint disease, (3) prior shld surgery, (4) SC tendon tear, (5) pt inability to complete questionnaires | Enrolled: 63 Analyzed: 63 Withdrawals: 7 Duration since symptom onset, mean (range): ≥3 mo (NR) Type of tear: NR Tendon(s) torn: SS, SS+IS GROUP 1 N: 31 Age, mean±SD (range): 61.8 yr (51–79 yr) Males %: 58.1 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: 80.6 Comorbidities: NR GROUP 2 N: 32 Age, mean±SD (range): 64.7 yr (53–81 yr) Males %: 46.9 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: 71.9 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (7); labral repair (NR) Duration of immobilization: 6 wk Duration of rehab: 6 mo. Rehab components: passive stretching (day 1–6 wk); active- assisted stretching (wk 6); strengthening (wk 10/12–6 mo) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (9); biceps tenotomy (NR) Duration of immobilization: 6 wk Duration of rehab: 6 mo Rehab components: passive stretching (day 1); active-assisted stretching (wk 6); strengthening (wk 10/12–6 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS, cortisone injection, NSAID, rest | HRQL: NR Function: • UCLA Pain: NR ROM: • flexion • internal rotation • external rotation Strength: NR Other: NR | Repairing a type 2 SLAP lesion when associated with a RC tear has no advantages. RCR and biceps tenotomy provides better clinical outcomes in comparison with repair of type 2 SLAP lesion and the RC tears. |
| Franceschi F, 2007 Country: Italy Treatment category: Operative technique Questions: Q2, Q5 Funding: NR ROB: High | Recruitment dates: Feb to Sep 2004 Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): 22.5 mo (18 mo–2.1 yr) Inclusion criteria: (1) RC tears, (2) no shld instability, (3) no fracture of glenoid or greater/lesser tuberosity, (4) symptoms >3mo, (5) failure of conservative tx, (6) unretracted and mobile FTT Exclusion criteria: (1) inablilty to complete questionnaire, (2) inflammatory joint disease, (3) retracted and insufficient mobile lesion to allow double- row technique, (4) prior surgery on affected shld | Enrolled: 60 Analyzed: 52 Withdrawals: 8 Duration since symptom onset, mean (range): ≥3 mo (NR) Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+SC GROUP 1 N: 30 Age, mean (range): 59.6 yr (45–80 yr) Males %: 53.3 Cause of tear: NR Tear size: lg, mass Dominant shoulder %: 63.3 Comorbidities: NR GROUP 2 N: 30 Age, mean±SD (range): 63.5 yr (43–76 yr) Males %: 40 Cause of tear: NR Tear size: lg, mass Dominant shoulder %: 66.7 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): NR Technique: double-row mattress suture, anchors, side-to-side sutures Duration of immobilization: 6 wk Duration of rehab: 6 mo Rehab components: passive stretching (wk 1–10); strengthening (wk 10/12–6 mo) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): NR Technique: single-row mattress suture, anchors Duration of immobilization: 6 wk Duration of rehab: 6 mo Rehab components: passive stretching (wk 1–10); strengthening (wk 10 or 12–26) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: • UCLA Pain: NR ROM: • flexion • external rotation • internal rotation Strength: NR Other: • cuff integrity | Comparable clinical outcomes were present at 2 yr for single and double-row techniques. |
| Franceschi F, 2007 Country: Italy Treatment category: Operative approach Questions: Q2, Q5 Funding: NR ROB: High | Recruitment dates: 1999 to 2001 Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): 3.9 yr (3–4.9 yr) Inclusion criteria: (1) RC repair with severe associated bicep tendon lesion, (2) failure of nonoperative tx Exclusion criteria: NR | Enrolled: 22 Analyzed: 22 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, IS, SC GROUP 1 N: 11 Age, mean±SD (range): 60.3±12.4 yr (41–79 yr) Males %: 54.5 Cause of tear: degenerative (6), traumatic (5) Tear size: mass Dominant shoulder %: 63.6 Comorbidities: biceps pathology: dislocation (4), unstable (3), tear ≥50% (4) GROUP 2 N: 11 Age, mean±SD (range): 58.1±14.5 yr (40–81 yr) Males %: 45.5 Cause of tear: degenerative (6), traumatic (5) Tear size: mass Dominant shoulder %: 72.7 Comorbidities: biceps pathology: dislocation (3), unstable (4), tear ≥50% | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenodesis (all) Duration of immobilization: 6 wk Duration of rehab: 6 mo Rehab components: passive stretching (day 1–wk 6); active-assisted stretching (wk 6–10/12); strengthening (wk 10/12–6 mo) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (all) Duration of immobilization: 6 wk Duration of rehab: 6 mo Rehab components: passive stretching (day 1–wk 6); active-assisted stretching (wk 6–10/12); strengthening (wk 10/12–6 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS, cortisone injection, NSAID, rest | HRQL: NR Function: • UCLA Pain: NR ROM: • flexion • internal rotation • external rotation Strength: NR Other: NR | No difference was found between detaching and not detaching the biceps after including it in the RCR. |
| Fuchs B, 2006 Country: Switzerland Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 3.2 yr (2–4.4 yr) Inclusion criteria: (1) single RC tendon FTT, (2) pain and/or disability following ≥3 mo nonoperative tx, (3) used of arm at or above head level, (4) use of an abduction brace for 6 wk postoperative Exclusion criteria: (1) FTT involving 2 tendons, (2) prior RCR, (3) moderate-severe OA of glenohumeral joint, (4) history of infection, (5) glenohumeral stiffness with loss of 20° of passive elevation and 10° of passive external rotation compared to contra-lateral side | Enrolled: 32 Analyzed: 32 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, SC GROUP 1 N: 32 Age, mean±SD (range): 59 yr (40–75 yr) Males %: 65.6 Cause of tear: NR Tear size: NR Dominant shoulder %: 71.9 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): capsulectomy (all) Duration of immobilization: 6 wk. Duration of rehab: NR Rehab components: passive stretching immediately post operative; active stretching (wk 6) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: NR | HRQL: NR Function: • CMS Pain: • VAS (15 points) ROM: • flexion (active) • abduction (active) • internal rotation (active) • external rotation (active) Strength: • abduction strength (kilos) • abduction strength (points) Other: • activities of daily living • cuff integrity | Direct, open repair of a complete isolated tear of one tendon resulted in significant improvement in clinical and structural measures. |
| Gartsman GM, 2004 Country: USA Treatment category: Operative approach Questions: Q2 Funding: NR ROB: High | Recruitment dates: NR Study design (trial type): RCT (parallel) Enrolled consecutively: yes Followup duration, mean±SD (range): 15.6±3.3 mo (NR) Inclusion criteria: (1) isolated, repairable SS tendon FTT, (2) type 2 acromion Exclusion criteria: (1) type 1/3 acromion, (2) two-tendon tears (3) PTT, (4) irrepairable tears, (5) concomittant procedure, (6) WCB claim, (7) prior surgery | Enrolled: 93 Analyzed: 93 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS GROUP 1 N: 47 Age, mean±SD (range): 59.3 yr (39–81 yr) Males %: 57.4 Cause of tear: mean: 2.1 cm Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 46 Age, mean±SD (range): 60 yr (37–79 yr) Males %: 52.2 Cause of tear: NR Tear size: mean: 2.3 cm Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: CPM (day 1–wk 2); passive stretching (wk 2–6); active stretching (wk 6–12); strengthening (wk12 onward) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): none Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: CPM (day 1–wk 2); passive stretching (wk 2–6); active stretching (wk 6–12); strengthening (wk 12 onward) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES Pain: NR ROM: NR Strength: NR Other: NR | Arthroscopic subacromial decompression does not appear to change the functional outcome after arthroscopic RCR. |
| Gartsman GM, 1998 Country: USA Treatment category: Operative Questions: Q2, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: N | Recruitment dates: Jan to Dec 1994 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 12.7 mo (11–21 mo) Inclusion criteria: 1) reparable FTT of one or more tendons; 2) verified at operation Exclusion criteria: 1) previous shld operation; 2) PTT; 3) irreparable tears; 4) WCB claim; 5) acute tear repaired <3 mo after injury | Enrolled: 50 Analyzed: 50 Withdrawals: 0 Duration since symptom onset, mean (range): 20.4 mo (6 mo–12 yr) Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+IS+TM, SS+IS+SC, SS+SC GROUP 1 N: 50 Age, mean±SD (range): 61 yr (37–78 yr) Males %: 52 Cause of tear: NR Tear size mean (range): length: 28.2 mm (0–55 mm); width:12.5 mm, (5–30 mm); area: 406 mm2 (50–1500 mm2) Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures: acromioplasty (NR) Duration of immobilization: NR Duration of rehab: 1 yr Rehab components: passive stretching (wk 1–6); active stretching (wk 6–1 yr); strengthening (wk 12–1 yr) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: physical therapy, cortisone injection, NSAID | HRQL: • SF-36 Function: • CMS • UCLA • ASES Pain: NR ROM: NR Strength: NR Other: NR | Comparison of pre-operative and postoperative responses demonstrated highly significant improvements in patient assessment of general health and shld function. |
| Gartsman GM, 1997 Country: USA Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: N | Recruitment dates: 1984 to 1991 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 5.3 yr (4–9.8 yr) Inclusion criteria: (1) mass RC tear involving 2–4 tendons, could not be closed without excessive tension after lysis of intra and extra articular adhesions; (2) release of the coracohumeral ligament and rotator interval and incision of the superior and posterior aspects of the capsule Exclusion criteria: (1) reparable tear, (2) partial tendon repair or previous RC operation | Enrolled: 33 Analyzed: 33 Withdrawals: 0 Duration since symptom onset, mean (range): 17 mo (6 mo–8 yr) Type of tear: FTT Tendon(s) torn: SS+IS, SS+SC GROUP 1 N: 33 Age, mean±SD (range): 62 yr (42–77 yr) Males %: 90.9 Cause of tear: NR Tear size: mass Dominant shoulder %: 75.8 Comorbidities: biceps pathology: (absent (12); frayed but intact (14); hypertrophied (4)); osteoarthrosis (10); AC joint; OA of glenohumeral (4) | GROUP 1 Surgical approach: open Type of surgery: debidement Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (1)/(1); resection of greater tuberosity (7) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (day 1 until max movement achieved); active stretching (wk 3); strengthening (wk 6 until pain absent) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: • UCLA • ASES • CMS Pain: • VAS ROM: NR Strength: NR Other: NR | Open operative debridement and decompression of irreparable tears of RC showed improvements in functional scores. |
| Gazielly DF, 1994 Country: France Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: Sep 1985 to Nov 1989 Study design: Before-and-after Enrolled consecutively: yes Followup duration, mean (range): 4 yr (2–6 yr) Inclusion criteria: (1) no previous cuff surgery, (2) FTT, (3) follow up ≥2 yr Exclusion criteria: (1) PTT, (2) stiff shld | Enrolled: 98 Analyzed: 98 Withdrawals: 0 Duration since symptom onset, mean±SE (range): 24.19±3.05 mo (1 mo–10 yr) Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+IS+SC GROUP 1 N: 98 Age, mean±SD (range): 56 yr (35–77 yr) Males %: 63.3 Cause of tear: degenerative (31), traumatic (67) Tear size: NR Dominant shoulder %: 73.5 Comorbidities: degeneration of LHB (21); torn LHB (6) | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 6 wk. Duration of rehab: NR Rehab components: passive stretching (wk 1–6); active-assisted stretching (wk 6–8); strengthening (wk 12) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: exercise | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: • cuff integrity | Predictive clinical factors for recurrence included overall CMS, reduce ability to do daily activities, decreased ROM and muscle strength. CMS reflected accurate, reliable and reproducible results. |
| Ghroubi S, 2008 Country: Tunisia Treatment category: Nonoperative Questions: Q3, Q5 Funding: NR BA Quality: Consecutive: U Followup: U Outcome assessment: U | Recruitment dates: Jan 1995 to Dec 2004 Study design: before-and-after Enrolled consecutively: NR Followup duration, mean (range): 7 yr (4–12 yr) Inclusion criteria: (1) RC tear, (2) complete baseline evaluation, (3) ≥4 yr followup, (4) adhere to rehab program Exclusion criteria: (1) traumatic rupture; (2) infections, inflammation, tumor or neurological symptoms; (3) severe psychological problems; (4) refuse examination or interview | Enrolled: 59 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: FTT (39); PTT (20) Tendon(s) torn: SS, SS+IS GROUP 1 N: 59 Age, mean±SD (range): 61 yr (46–75 yr) Males %: 35.6 Cause of tear: degenerative (59) Tear size: NR Dominant shoulder %: 72.9 Comorbidities: NR | GROUP 1 Intervention: strengthening, soft tissue massage, corticosteroid injection, NSAIDs, analgesics, movement awareness Drug name: NR Duration of treatment: varied by PT Treatment regime: varied by PT Degree of supervision: NR Treatment provider: PT | HRQL: • SF-36 Function: • CMS Pain: • VAS ROM: • abduction (active) • flexion (active) • external rotation (active) • internal rotation (active) Strength: NR Other: • return to work • pt compliance • pt satisfaction • required surgery | Study results demonstrate benefits of individualized rehab program combined with medical tx. |
| Gladstone JN, 2007 Country: USA Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: Y | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: NR Followup duration, mean (range): 1 yr (12–15 mo) Inclusion criteria: pre-and postoperative MRI permitted evaluation of fatty infiltration Exclusion criteria: (1) glenohumeral arthritis, (2) fracture, (3) osteonecrosis | Enrolled: 38 Analyzed: 38 Withdrawals: 0 Duration since symptom onset, mean (range): 10.5 mo (2 wk–4.3 yr) Type of tear: FTT Tendon(s) torn: SS, IS GROUP 1 N: 15 Age, mean±SD (range): all groups: 62 yr (3–6.5 yr) Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 23 Age, mean±SD (range): see group 1 Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): tendon mobilization Duration of immobilization: 6 wk Duration of rehab: 3–4 mo Rehab components: passive stretching (wk 1–6); active stretching (wk 6); strengthening (wk 6–12 or 16) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): NR Duration of immobilization: 6 wk Duration of rehab: 3–4 mo Rehab components: passive stretching (wk 1–6); active stretching (wk 6); strengthening (wk 6–12 or 16) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • ASES Pain: • VAS ROM: NR Strength: • flexion • external rotation Other: • cuff integrity | Fatty infiltration and muscle atrophy of the IS and SS significantly affect the functional outcome after RCR even if pain is consistently relieved. Tear size appears to have the most influential effect on repair integrity. Repairs should be performed prior to more significant deterioration of cuff muscle to optimize outcomes. |
| Grasso A, 2009 Country: Italy Treatment category: Operative technique Questions: Q2, Q6 Funding: No funding ROB: High | Recruitment dates: NR Study design: RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): 24.8±1.4 mo Inclusion criteria: (1) repairable FTT of SS or the posterior- superior RC ± biceps pathology or rotator interval involvement Exclusion criteria: (1) PTT, (2) irreparable FTT, (3) extension of tear to SC, (4) isolated SC tear, (5) reparable labral pathology, degenerative OA of glenohumeral joint, symptomatic OA of AC joint, RC arthropathy, previous surgery on the same shoulder, WCB | Enrolled: 80 Analyzed: 72 Withdrawals: 8 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS GROUP 1 N: 37 Age, mean±SD (range): 58.3±10.3 yr Males %: 43 Cause of tear: NR Tear size: NR Dominant shoulder %: 73 Comorbidities: NR GROUP 2 N: 35 Age, mean±SD (range): 55.2±6.5 yr Males %: 51 Cause of tear: NR Tear size: NR Dominant shoulder %: 83 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); tenotomy (12); tenodesis (8) Technique: single-row repair Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive, active and active-assisted stretching (4–8 wk); strengthening exercises (10–12 wk); open kinetic chain exercises (13–16 wk) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); tenotomy (13); tenodesis (7) Technique: double-row repair Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive, active and active-assisted stretching (4–8 wk); strengthening exercises (10–12 wk); open kinetic chain exercises (13–16 wk) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • DASH • Work-DASH Pain: NR ROM: NR Strength: • Strength (lbs) Other: NR | At short-term followup, there was no significant difference in clinical or functional outcomes between single-row and double-row repair. |
| Hata Y, 2004 Country: Japan Treatment category: Operative approach Questions: Q2 Funding: No funding NOS: 4*/8* | Recruitment dates: 1994 to 1997 Study design: retrospective cohort Enrolled consecutively: yes Followup duration, mean (range): all: 4 yr (2–6.8 yr); group 1: 2.6 yr (2–3.1 yr); group 2: 5.1 yr (3.8–6.8 yr) Inclusion criteria: RC Exclusion criteria: (1) tears >3 tendons, (2) tendon retraction >5cm | Enrolled: 78 Analyzed: 78 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 43 Age, mean±SD (range): 58.1 yr (31–78 yr) Males %: 58.1 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 35 Age, mean±SD (range): 60.6 yr (39–71 yr) Males %: 60 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 3 wk. Duration of rehab: NR Rehab components: passive and active stretching (day 1–wk 6); strengthening (wk 4); active-assisted stretching (wk 4); active stretching and strengthening (wk 6); strenuous muscle training (intrinsic or extrinsic) (2 mo) Rehab regime: NR GROUP 2 Surgical approach: mini-open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: 3 wk. Duration of rehab: NR Rehab components: passive and active stretching (day 1 wk–6); strengthening (wk 4); active-assisted stretching (wk 4); active stretching and strengthening (wk 6); strenuous muscle training (intrinsic or extrinsic) (2 mo) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: NR • UCLA Pain: NR ROM: NR Strength: NR Other: • time to return to work • cuff integrity | Less postoperative atrophy of the deltoid muscle and quick recovery of pts, were obtained by the mini-open repair of RC tears than conventional open repair. |
| Hawkins RH, 1995 Country: Canada Treatment category: Nonoperative Questions: Q3, Q6 Funding: Foundation Other: German BA Quality: Consecutive: Y Followup: N Outcome assessment: Y | Recruitment dates: NR Study design: before- and-after Enrolled consecutively: yes Followup duration, mean (range): 3.8 yr (2.6–4.6 yr) Inclusion criteria: (1) FTT, (2) within geographic area, (3) symptomatic, non- acute Exclusion criteria: NR | Enrolled: 50 Analyzed: 33 Withdrawals: 17 Duration since symptom onset, mean±SD (range): 59.8±116.7 mo (1 mo–25 yr) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 50 Age, mean±SD (range): 59.6±10.5 yr (NR) Males %: 54 Cause of tear: degenerative (12), traumatic (21) Tear size: all sizes Dominant shoulder %: 52 Comorbidities: NR | GROUP 1 Intervention: active ROM, strengthening Drug name: NR Duration of treatment: >10 wk Treatment regime: Frequency–daily for 10 wk, 3×/wk.; Intensity–3 sets × 10 reps of 6 exercises Degree of supervision: unsupervised Treatment provider: PT Additional comments: exercises at home; PT taught and reinforced technique at visits | HRQL: NR Function: • CMS Pain: • VAS ROM: NR Strength: NR Other: • work and recreation status • satisfaction scale • sleep loss | Pts who have insurance claims or are experiencing significant sleep loss due to pain are unlikely to be satisfied with nonoperative tx. |
| Hayes K, 2004 Country: Australia Treatment category: Post-op rehabilitation Questions: Q2 Funding: Government ROB: High | Recruitment dates: Feb 1999 to Mar 2001 Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration (endpoint): 24 wk Inclusion criteria: RCR Exclusion criteria: (1) irreparable tear; (2) previous shld surgery; (3) additional procedure: humeral/clavical/scapula fracture; (4) RA, DM | Enrolled: 58 Analyzed: 42 Withdrawals: 16 Duration since symptom onset, mean±SD (range): Group 1: 12±16 mo (0 mo–4 yr); Group 2: 19±27 mo (1 mo–8 yr) Type of tear: FTT (50); PTT (8) Tendon(s) torn: SS, SS+IS, SS+SC, SS+IS+SC GROUP 1 N: 26 Age, mean±SD (range): 58±10 yr (41–81 yr) Males %: 76.9 Cause of tear: degenerative (7), traumatic (19) Tear size: mean: 5 cm2 Dominant shoulder %: 76.9 Comorbidities: NR GROUP 2 N: 32 Age, mean±SD (range): 62±11 yr (42–83 yr) Males %: 62.5 Cause of tear: degenerative (18), traumatic (14) Tear size: mean: 6 cm2 Dominant shoulder %: 59.4 Comorbidities: NR | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 1 day Duration of rehab: 24 wk Rehab components: active stretching (day 2–wk 6); active stretching and strengthening (wk 6–24); Modality–heat/cold, day 2–7 Rehab regime: Frequency–1–5×/day; Intensity–5–10 reps per position GROUP 2 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 1 day Duration of rehab: 24 wk. Rehab components: active therapy (day 2–wk 6); active stretching and strengthening (wk 6–24); Modality–heat/cold, day 2–7 Rehab regime: Frequency–1–5×/day; Intensity–5–10 reps per position PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • Insalata Pain: NR ROM: • flexion (passive) • external rotation (passive) • abduction (passive) Strength: • internal rotation • external rotation • flexion Other: NR | Outcomes for patients allocated to individualized PT tx after RCR were no better than for patients receiving standardized home exercise regime. |
| Heers G, 2005 Country: Germany Treatment category: Nonoperative Questions: Q3 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: U | Recruitment dates: NR Study design: prospective cohort treated as before-and- after Enrolled consecutively: NR Followup duration (endpoint): 12 wk Inclusion criteria: (1) RC tear, (2) 40–70 yr Exclusion criteria: (1) abnormal subacromial spur, (2) previous shld surgery | Enrolled: 34 Analyzed: 30 (shld: 38) Withdrawals: 4 Duration since symptom onset, mean±SD (range): Group 1: 2.5±2.9 yr; Group 2: 2.4±2.0 yr; Group 3: 5.9±4 yr; All: 3.4±3.3 yr Type of tear: FTT (24); PTT (14) Tendon(s) torn: Group 1–2: SS; Group 3: SS, IS ALL GROUPS N: Group 1, shld: 14; Group 2, shld: 14; Group 3, shld: 10 Age, mean±SD (range): all groups: 60.4 yr (44–69 yr) Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | All GROUPS Intervention: passive and active ROM, strengthening Drug name: NR Duration of treatment: 12 wk. Treatment Regime: Frequency–daily; Intensity–40 min/day, 5 sets of 10 reps for 11 exercises Degree of supervision: indirect Treatment provider: physician | HRQL: NR Function: • CMS Pain: • night pain (15-point VAS) ROM: • external rotation • abduction • anteversion Strength: NR Other: NR | Patients with RC defects benefit from simple home exercises independent from the size of the defect. |
| Henn RF III, 2008 Country: USA Treatment category: Operative Questions: Q2, Q5 Funding: No funding BA Quality: Consecutive: U Followup: U Outcome assessment: U | Recruitment dates: Jan 1998 to Sep 2001 Study design: prospective cohort treated as before- and-after Enrolled consecutively: NR Followup duration, mean±SD (range): 54.1±7.6 wk (32.7–88.7 wk) Inclusion criteria: (1) primary repair of a unilateral symptomatic chronic FTT, (2) failed nonoperative tx Exclusion criteria: (1) previous shld surgery (2) partial/incomplete repair of a mass tear, (3) glenohumeral arthritis | Enrolled: 125 Analyzed: 125 Withdrawals: 0 Duration since symptom onset, mean±SD (range): Group 1: 13.0±13.9 mo (3 mo–5.3 mo); Group 2: 17.5±29.9 mo (13 mo 18–yr) All: 16.0±25.9 mo (3 mo–18 yr) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 39 Age, mean±SD (range): 52.5±1.6 yr (32–79 yr) Males %: 61.5 Cause of tear: NR Tear size: NR Dominant shoulder %: 59 Comorbidities, mean±SD (range): number of comorbidities: 1.8±1.5 (0–5) GROUP 2 N: 86 Age, mean±SD (range): 57.8±1.3 yr (35–84 yr) Males %: 55.8 Cause of tear: NR Tear size: NR Dominant shoulder %: 68.6 Comorbidities, mean±SD (range): number of comorbidities: 2.0±1.5 (0–6) | GROUP 1 Surgical approach: open (7); mini-open (19); all-arthoscopic (13) Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (1)/(2); bicep relocation (2); clavicular resection (14) Duration of immobilization: 5 wk Duration of rehab: 5 wk Rehab components: mini open/open surgery: passive stretching; all- arthroscopic repair: passive stretching Rehab regime: NR GROUP 2 Surgical approach: open (19); mini-open (43); all-arthoscopic (24) Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (1)/(3); bicep relocation (3); clavicular resection (34); Duration of immobilization: 5 wk Duration of rehab: 5 wk Rehab components: mini open/open surgery: passive stretching; all- arthroscopic repair: passive stretching Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS, cortisone injection | HRQL: • VAS-QOL • SF-36 Function: • VAS shld function • STT • DASH Pain: • VAS ROM: NR Strength: NR Other: NR | Pts with worker‘s compensation claims reported worse outcomes, even after controlling for confounding factors. |
| Hsu SL, 2007 Country: Taiwan Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: NR Study design: before-and- after Enrolled consecutively: yes Followup duration, mean (range): 48.6 mo (24–85 mo) Inclusion criteria: (1) RC tear with associated shld stiffness, (2) ≥2yr followup Exclusion criteria: (1) previous operations, (2) traumatic fracture on the involved shld | Enrolled: shld: 47 Analyzed: shld: 47 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT (20); PTT (27) Tendon(s) torn: Group 1 and 3: NR; Group 2: SS GROUP 1 N: shld: 27 Age, mean±SD (range): 54±7 yr (NR) Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: shld stiffness (all); DM - 10 (11 shlds); rectal carcinoma (2); thalassemia (1); hypertension (1); cervical carcinoma (1); bronchietasis (1) GROUP 2 N: shld: 15 Age, mean±SD (range): 52±10 yr(NR) Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: see group 1 GROUP 3 N: shld: 5 Age, mean±SD (range): 62±11 yr (NR) Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: see group 1 | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures: acromioplasty (all); manipulation (all); surgical lysis of the adhesive tissue (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (day 2); active-assisted stretching (day 3/4); active- stretching (day 7/10) Rehab regime: NR GROUP 2 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all); manipulation (all); surgical lysis of the adhesive tissue (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (day 2); active-assisted stretching (day 3/4); active stretching (day 7/10) Rehab regime: NR GROUP 3 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all); manipulation (all); surgical lysis of the adhesive tissue (all); deltoid flap transfer (1) Duration of immobilization: 3 day Duration of rehab: NR Rehab components: passive stretching (day 3/4); active-assisted stretching (wk 2) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: physical therapy | HRQL: NR Function: • CMS Pain: NR ROM: • abduction • flexion • external rotation Strength: NR Other: NR | Gentle manipulation, extensive lysis of adhesions, and acromioplasty with RCR is a satisfactory procedure for pts with RC tear and associated shld stiffness. |
| Iannotti JP, 2006 Country: USA Treatment category: Operative augmentation Questions: Q2, Q5, Q6 Funding: Government, industry ROB: High | Recruitment dates: Jan 2002 to Jan 2004 Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): 14 mo (12–26.5 mo) Inclusion criteria: (1) a tear of both SS and IS tendons (MRI), (2) >18 yrs old, (3) tear of 3 mo duration, (4) fully reparable tear Exclusion criteria: (1) prior shld surgery, (2) cervical spine disease, (3) adhesive capsulitis, (4) glenohumeral arthritis | Enrolled: 32 Analyzed: 30 Withdrawals: 2 Duration since symptom onset, mean (range): ≥ 3 mo (NR) Type of tear: FTT Tendon(s) torn: SS+IS GROUP 1 N: 16 Age, mean±SD (range): 58 yr (NR) Males %: 68.8 Cause of tear: NR Tear size: lg, mass Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 16 Age, mean±SD (range): 57 yr (NR) Males %: 75 Cause of tear: NR Tear size: lg, mass Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (4); osacromiale repair (3) Technique: polyester tape through bone tunnels; Mason-Allen and horizonal matterness sutures; simple or figure 8 suture configuration (convergence repairs) Augmentation: circular restore path (10 cm diameter) Duration of immobilization: 1 wk Duration of rehab: NR Rehab components: passive stretching (wk 1–8); active stretching (wk ≥8); strengthening (wk ≥10/12) Rehab regime: NR GROUP 2 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (5); os acromiale repair (1) Technique: polyester tape through bone tunnels; Mason-Allen and horizonal matterness sutures; simple or figure 8 suture configuration (convergence repairs) Augmentation: NR Duration of immobilization: 1 wk Duration of rehab: NR Rehab components: passive stretching (wk 1–8); active stretching (wk ≥8); strengthening (wk ≥10/12) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • PENN Pain: NR ROM: NR Strength: NR Other: • cuff integrity | Augmentation of the surgical repair of large and massive chronic RC tears with porcine small intestine submucosa did not improve the rate of tendon healing or the clinical outcome scores. |
| Iannotti JP, 1996 (10-year followup in Galatz LM, 2001) Country: USA Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: Jun 1988 to Jun 1990 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 10 yr Inclusion criteria: FTT Exclusion criteria: (1) operation within 3 mo. of injury, (2) previous shld surgery | Enrolled: 46 Analyzed: 40 (shld: 41) Withdrawals: 6 Duration since symptom onset, mean (range): 8.9±7.4 mo. (3–36 mo.) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 40 (shld: 41) Age, mean±SD (range): 55±11 yr. (39–71 yr.) Males %: 77.5 Cause of tear: degenerative (13), traumatic (27) Tear size: all sizes Dominant shoulder %: 72.5 Comorbidities: rupture of LHB (7) | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all); tendon transfer (2) Duration of immobilization: NR Duration of rehab: NR Rehab components: active-assisted stretching–wk. 1–6; stretching–wk. ≥6; strengthening–wk. ≥8/12 Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: exercise, cortisone injection | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: • time to return to work | Normalized CMS show a significant correlation between functional outcomes and tear size. |
| Ide J, 2007 Country: Japan Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: Apr 2001 to Oct 2004 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 36.1 mo. (24–60 mo.) Inclusion criteria: (1) arthroscopic repair of FTT, (2) MRI of involved shld pre- or post-op, (3) followup >2 yr Exclusion criteria: (1) irreparable RC tears, (2) partial RC repair, (3) stage 3 or 4 fatty infiltration, (4) pre-operative cuff tear arthropathy, (5) failed RC repair, (6) WCB claim | Enrolled: 20 Analyzed: 20 Withdrawals: 0 Duration since symptom onset, mean (range): 2.7 mo. (1–6 mo.) Type of tear: FTT Tendon(s) torn: SS+SC, SS+IS+SC GROUP 1 N: 20 Age, mean±SD (range): 61.7 yr. (45–79 yr.) Males %: 85 Cause of tear: traumatic (20) Tear size: med Dominant shoulder %: 75 Comorbidities: biceps tendon complete tear (5); biceps tendon dislocated/subluxated (6); biceps tendon partial tear (3); subluxation and partial tear of biceps tendon (3) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): biceps tenotomy/tenodesis (5)/(7); coracoplasty (6) Duration of immobilization: 6 wk. Duration of rehab: 3–6 mo. Rehab components: passive stretching and active-assisted stretching–day 1-wk. 4; active stretching–wk. ≥6; strengthening–wk. 9–12 Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • JOA • UCLA Pain: NR ROM: • flexion • external rotation • internal rotation Strength: NR Other: • cuff integrity | For the Tx of combined RC tears involving SC tendon, arthroscopic RCR with use of the suture anchor technique is a safe and effective procedure. It can reduce shoulder pain or improve function and ROM. Integrity of the repair can be affected by patients age and degree of tendon retraction. |
| Ide J, 2005 Country: Japan Treatment category: Operative Questions: Q2 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: 1999 to 2002 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 39 mo (25–57 mo) Inclusion criteria: articular side SS PTT involving ≥6 mm of the tendon, treated with arthroscopic transtendon repair Exclusion criteria: (1) arthroscopic SLAP repair, (2) arthroscopic Bankart repair | Enrolled: 21 Analyzed: 17 Withdrawals: 4 excluded (SLAP repair [3]; Bankart repair [1]) Duration since symptom onset, mean (range): 11 mo (7–24 mo) Type of tear: PTT Tendon(s) torn: SS GROUP 1 N: 21 Age, mean±SD (range): 42 yr (17–51 yr) Males %: 66.7 Cause of tear: degenerative (10), traumatic (7) Tear size: NR Dominant shoulder %: 66.7 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): NR Duration of immobilization: 4 wk Duration of rehab: 3 mo Rehab components: CPM (day 1–3 mo); active-assisted stretching (wk 2–3 mo); strengthening (wk 4/6–3 mo) Rehab regime: Frequency–NR; Intensity–CPM, 2 hr/day PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • UCLA • JOA Pain: NR ROM: NR Strength: NR Other: • Number of pts returning to original level of sport | Arthroscopic transtendon repair is a safe, reliable procedure in patients with grade III PTT. |
| Ide J, 2005 Country: Japan Treatment category: Operative approach Questions: Q2, Q5, Q6 Funding: NR NOS: 7*/8* | Recruitment dates: 1996 to 2001 Study design: prospective cohort Enrolled consecutively: yes Followup duration, mean (range): 49 mo (25–83 mo) Inclusion criteria: FTT including mass tears Exclusion criteria: (1) PTT, (2) irreparable RC tear reconstructed with implatation of fascia lata, (3) SC repair/prior surgery on shld, (4) other significant intraarticular pathology, (5) WCB claim | Enrolled: NR Analyzed: 100 Withdrawals: NR Duration since symptom onset, mean (range): Group 1: 8 mo (2–24 mo); Group 2: 6.4 mo (2–36 mo) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 50 Age, mean±SD (range): 57.1 yr (24–72 yr) Males %: 78 Cause of tear: degenerative (18), traumatic (32) Tear size: all sizes Dominant shoulder %: 78 Comorbidities: NR GROUP 2 N: 50 Age, mean±SD (range): 57 yr (25–78 yr) Males %: 82 Cause of tear: degenerative (24), traumatic (26) Tear size: all sizes Dominant shoulder %: 62 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: 3 wk Duration of rehab: 3 mo Rehab components: passive stretching and CPM (day 1–wk 6/9); strengthening (wk 6–9); active-assisted stretching (wk 2–4) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: 3 wk Duration of rehab: 3 mo Rehab components: passive stretching and CPM (day 1–wk 6/9); active- assisted stretching (wk 2–4); strengthening (wk 6–9) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • UCLA • JOA Pain: NR ROM: NR Strength: NR Other: • pt satisfaction | Equivalent outcomes obtained by open and arthroscopic RCR of small to massive RC tears. Regardless of repair methods, outcomes in pts with large to massive tears were inferior to those in patients with small to medium tears. |
| Ito J, 2003 Country: Japan Treatment category: Operative augmentation Questions: Q2, Q5 Funding: NR NOS: 4*/8* | Recruitment dates: 1983 to 1987 Study design: retrospective cohort Enrolled consecutively: NR Followup duration, mean (range): 3.7 yr (2–8.4 yr) Inclusion criteria: (1) surgical tx for RC tear between 1983–1997, (2) lg or mass tear Exclusion criteria: NR | Enrolled: 28 (shld: 30) Analyzed: 21 (shld: 21) Withdrawals: 7 Duration since symptom onset, mean±SD (range): Group 1: 5.8±4.7 mo (NR); Group 2: 4.1±2.9 mo (NR) Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 9 Age, mean±SD (range): 62.8±6.9 yr (49–70 yr) Males %: 66.7 Cause of tear: NR Tear size: lg, mass Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 12 Age, mean±SD (range): 52.3±8.6 yr (36–66 yr) Males %: 83.3 Cause of tear: NR Tear size: lg, mass Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Augmentation: Patch graft placed between the margin of the RC and the anatomical insertion at the humeral head in order to avoid excessive tension Duration of immobilization: 5 wk Duration of rehab: NR Rehab components: passive stretching (day 1–wk 5); active stretching (wk 5) Rehab regime: NR GROUP 2 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Augmentation: McLaughlin procedure, the margin of the RC was attached to the ‘anatomical insertion’ at the humeral head Duration of immobilization: 5 wk Duration of rehab: NR Rehab components: passive stretching (day 1–wk 5); active stretching (wk 5) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: NR Function: • JOA Pain: NR ROM: • abduction • external rotation • flexion Strength: NR Other: NR | Based on this study, patch grafts are considered to have the advantages of achieving anatomical repair with minimal restriction of ROM and minimal occurrence of retearing. |
| Kane TP, 2008 Country: England Treatment category: Nonoperative Questions: Q3, Q5 Funding: NR BA Quality: Consecutive: Y Followup: U Outcome assessment: U | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 6 mo (NR) Inclusion criteria: (1) painful endstage RC tear arthropathy, (2) medically unfit for surgery, (3) failure of nonoperative tx Exclusion criteria: (1) previous surgery, (2) nerve block | Enrolled: 12 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 12 Age, mean±SD (range): 68 yr (60–83 yr) Males %: 25 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: OA (11); RA (1); renal failure; DM; chronic obstructive pulmonary disease; heart failure | GROUP 1 Intervention: pulsed radio frequency ablation Drug name: NR Duration of treatment: NR Treatment Regime: Frequency–once in study duration; Intensity–6–8 min. Degree of supervision: direct one-to- one Treatment provider: NR | HRQL: NR Function: • CMS • OSS Pain: • VAS ROM: NR Strength: NR Other: NR | In patients with painful, endstage RC tear arthropathy who are not fit for surgery, pulsed radio frequency may be a useful therapeutic adjunct. |
| Kim SH, 2003 Country: South Korea Treatment category: Operative approach Questions: Q2, Q5, Q6 Funding: NR ROB: High | Recruitment dates: 1995 to 1998 Study design (trial type): CCT (parallel) Enrolled consecutively: yes Followup duration, mean (range): 39 mo (24–64 mo) Inclusion criteria: med/lg RC tears Exclusion criteria: (1) bilateral RC tear, (2) sm and mass tears, (3) advanced glenohumeral OA, (4) AC arthritis, (5) SLAP lesion, (6) previous surgery of shld, (7) tenodesis of biceps tendon, (8) anterior glenohumeral instability, (9) post traumatic stiff shld, (10) neurological deficit | Enrolled: NR Analyzed: 76 Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 34 Age, mean±SD (range): 58±9 yr (42–68 yr) Males %: 64.7 Cause of tear: degenerative (28), traumatic (6) Tear size: med, lg Dominant shoulder %: 88.2 Comorbidities (all groups): fraying of biceps tendons (6); early degenerative arthritis changes of glenoid articular surface (4) GROUP 2 N: 42 Age, mean±SD (range): 55±10.5 yr (42–75 yr) Males %: 64.3 Cause of tear: degenerative (33), traumatic (9) Tear size: med, lg Dominant shoulder %: 88.1 Comorbidities: see group 1 | GROUP 1 Surgical approach: mini-open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); manipulation (NR) Duration of immobilization: 3 wk Duration of rehab (N): <6 mo (18); 6– 12 mo (12); >12 mo (4) Rehab components: CPM (day 1–3); passive stretching (day 3–wk 3); active- assisted stretching (wk 3–6/9); strengthening (wk 6/9–6 mo) Rehab regime: Frequency–CPM, daily; Intensity–2 hr GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); manipulation (NR) Duration of immobilization: 3 wk Duration of rehab (N): <6 mo (21); 6– 12 mo (14); >12 mo (7) Rehab components: CPM (day 1–3); passive stretching (day 3–wk 3); active- assisted stretching (wk 3–wk 6/9); strengthening (wk 6/9–6 mo) Rehab regime: Frequency– CPM, daily; Intensity—2 hr PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • UCLA • VAS-function • ASES Pain: • VAS ROM: • flexion • internal rotation • external rotation Strength: • manual muscle testing Other: NR | For repair of medium and large RC tears there are equal outcomes between all arthroscopic repairs and unsuccessful arthroscopic repair converted to mini-open repair. |
| Kirschen-baum D, 1993 Country: USA Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: Y | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: NR Followup duration, (endpoint): 12 mo Inclusion criteria: 1) positive arthrogram of RC tears and shld pain limiting everyday activity Exclusion criteria: 1) shld pain on the nonoperative side | Enrolled: 25 Analyzed: 22 Withdrawals: 3 Duration since symptom onset, mean (range): 10 mo (2 mo–5 yr) Type of tear: NR Tendon(s) torn: SS, IS, TM GROUP 1 N: 25 Age, mean±SD (range): 62 yr (27–76 yr) Males %: 64 Cause of tear: degenerative (4), traumatic (21) Tear size: all sizes Dominant shoulder %: 56 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (23); excision of distal clavicle (14) Duration of immobilization: 2 wk Duration of rehab: NR Rehab components: passive stretching (wk 2); active stretching (wk 6); strengthening (wk 8–12) Rehab regime: Frequency– daily; Intensity–NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: NR Pain: • NR ROM: NR Strength: • isokinetic shld strength (abduction, flexion, external rotation) Other: NR | Shoulder strength is significantly improved by RC repair. |
| Klepps S, 2004 Country: USA Treatment category: Operative Questions: Q2, Q5, Q6 Funding: Foundation BA Quality: Consecutive: Y Followup: N Outcome assessment: Y | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: yes Followup duration, (minimum): 1 yr Inclusion criteria: (1) 40–80 yr, (2) able to communicate and give informed consent Exclusion criteria: (1) medically unstable for surgery; (2) concomitant disease: glenohumeral arthritis, fracture or osteonecrosis; (3) unable or unwilling to undergo MRI | Enrolled: 47 Analyzed: 32 Withdrawals: 15 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 47 Age, mean±SD (range): 64 yr (NR) Males %: NR Cause of tear: NR Tear size: all sizes Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open (24); mini-open (8) Type of surgery: repair Additional procedures (N): acromioplasty (NR); capsular release (13); distal clavicle resection (4) Duration of immobilization: 6 wk Duration of rehab: 3–4 mo Rehab components: passive stretching (wk 1–6); active stretching (wk 6–3/4 mo); strengthening (wk 6–3/4 mo) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES • CMS • UCLA Pain: • VAS ROM: NR Strength: • flexion (lb) • external rotation (lb) Other: • cuff integrity | Open and mini-open RCR restores RC function, regardless of RC integrity. |
| Klinger HM, 2005 Country: Germany Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: 1997 to 1999 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 31 mo (24–46 mo) Inclusion criteria: irreparable mass tear Exclusion criteria: reparable tears or previous procedures involving the shld | Enrolled: 33 Analyzed: 33 Withdrawals: 0 Duration since symptom onset, mean (range): 11 mo (6–23 mo) Type of tear: FTT Tendon(s) torn: SS+IS, SS+SC, SS+IS+SC GROUP 1 N: 33 Age, mean±SD (range): 69 yr (62–79 yr) Males %: 69.7 Cause of tear: NR Tear size: lg Dominant shoulder %: 69.7 Comorbidities: biceps pathology (23); degenerative OA (24%) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: debidement Additional procedures: acromioplasty (28); labral repair (NR); biceps tenotomy (6); resection of distal clavicle (1) Duration of immobilization: 0 Duration of rehab: NR Rehab components: active stretching–immediately post operative; stretching–NR Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: NR | Arthroscopic debridement early results suggest it is an acceptable tx for elderly pts with modest functional demands. |
| Klinger HM, 2005 Country: Germany Treatment category: Operative approach Questions: Q2, Q5 Funding: NR NOS: 4*/8* | Recruitment dates: 1998 to 2000 Study design: retrospective cohort Enrolled consecutively: NR Followup duration, mean (range): 2.6 yr (2–4 yr) Inclusion criteria: (1) mass irreparable RC tears, (2) persisting pain and functional disability after nonoperative Tx, (3) >6 mo arthroscopic dx of LHB pathology Exclusion criteria: (1) reparable RC tears, (2) previous shld surgery | Enrolled: 41 Analyzed: 41 Withdrawals: 0 Duration since symptom onset, mean (range): Group 1: 11 mo (6–23 mo); Group 2: 10 mo (6–18 mo) Type of tear: FTT GROUP 1 N: 24 Age, mean±SD (range): 66 yr (61–79 yr) Males %: 62.5 Cause of tear: NR Tear size: mass Tendon(s) torn: NR Dominant shoulder %: 58.3 Comorbidities: superior migration of humeral head (1); glenohumeral OA (1) GROUP 2 N: 17 Age, mean±SD (range): 68 yr (63–82 yr) Males %: 58.8 Cause of tear: NR Tear size: mass Tendon(s) torn: NR Dominant shoulder %: 58.8 Comorbidities: LHB: tendinosis (3); subluxation (5); prerupture (3); dislocation (6) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: debidement Additional procedures (N): acromioplasty (all); labral repair (NR) Duration of immobilization: NR Duration of rehab: NR Rehab components: active stretching (≥day 1); strengthening (NR) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: debidement Additional procedures (N): acromioplasty (alll); labral repair (NR); biceps tenotomy (17) Duration of immobilization: NR Duration of rehab: NR Rehab components: active stretching (≥day 1); strengthening (NR) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: NR | Arthroscopic RCR improves function, decreases pain, and improves shoulder score for most patients who underwent arthroscopic debridement of massive irreparable RC tears. Additional LHB tenotomy did not significantly influence the postoperative results at the latest followup. |
| Klintberg IH, 2009 Country: Sweden Treatment category: Post-op rehabilitation Questions: Q2, Q5 Funding: Academic ROB: High | Recruitment dates: NR Study design: RCT (parallel) Enrolled consecutively: yes Followup duration, mean (range): 2 yr Inclusion criteria: (1) FTT of RC Exclusion criteria: (1) No previous RC repair to the involved shoulder (2) interfering disease with treatment or shoulder function (e.g. RA, DM, neurological or psychological disease), (3) difficulties in reading & writing in Swedish | Enrolled: 18 Analyzed: 14 Withdrawals: 4 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 7 Age, mean±SD (range): NR Males %: NR Cause of tear: degenerative (NR); traumatic (4) Tear size: med, lg Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 7 Age, mean±SD (range): NR Males %: NR Cause of tear: degenerative (NR); traumatic (5) Tear size: med, lg, mass Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: NR Type of surgery: repair & debridement Additional procedures (N): NR Duration of immobilization: 4 wk Duration of rehab: >12 mo Rehab components: passive stretching (1–4 wk); active-assisted stretching with aquatic training program (4–6 wk); active stretching (6–8 wk); strengthening exercises ( 8–10 wk); aquatic training program (10–12 wk); eccentric load on RC (12–24 wk) Rehab regime: supervised PT 2–3 times/wk; active-assisted stretching-3x/day; aquatic training 1 (1x/week); strengthening exercises-2x/day; aquatic training 2 (2x/wk) Treatment provider: PT GROUP 2 Surgical approach: NR Type of surgery: repair & debridement Additional procedures (N): NR Duration of immobilization: 6 wk Duration of rehab: >24 mo Rehab components: passive stretching (1–6 wk); active and active-assisted stretching (6–10 wk); active-assisted stretching with aquatic training program (10–16 wk); strengthening exercises with aquatic program (16–24 wk); eccentric load on RC (24 wk) Rehab regime: supervised PT 2–3 times/wk; aquatic training 1 (1x/week); aquatic training 2 (2x/wk) Treatment provider: PT PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • Functional Score Index Pain: NR ROM: • adduction • external rotation in adduction • external rotation in abduction • internal rotation • extension • flexion Strength: bull; external rotation • internal rotation • elevation Other: NR | The progressive rehabilitation protocol has no adverse effects compared with the traditional protocol. |
| Ko SH, 2009 Country: South Korea Treatment category: Operative technique Questions: Q2, Q5, Q6 Funding: No funding ROB: High | Recruitment dates: Dec 2004 to Jun 2006 Study design: Prospective cohort Enrolled consecutively: no Followup duration, mean (range): 2.8 yr (2–3.4 yr) Inclusion criteria: (1) SS tear (0.5 – 1.5 cm) (2) fail at least 6 mo conservative tx, (3) subscapularis tears involving less than 0.5 mm, (4) stable biceps Exclusion criteria: (1) AC arthritis (2) biceps subluxation and dislocation, (3) SC tears that require repair, (4) stiffness requiring capsulatomy, (5) fractures around shoulder, (6) flexion<120 degrees, abduction <120 degrees, external rotation<0 degrees | Enrolled: 77 Analyzed: 71 Withdrawals: 6 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS GROUP 1 N: 35 Age, mean±SD (range): 53.6 yr (39–68) Males %: 51 Cause of tear: NR Tear size: sm, med Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 36 Age, mean±SD (range): 52.4 yr (15–68 yr) Males %: 47 Cause of tear: NR Tear size: sm, med Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (7) Technique: massive cuff stitch repair Duration of immobilization: NR Duration of rehab: >12 mo Rehab components: passive stretching (1–4 wk); active-assisted stretching (4 wk); active stretching (6 wk); strengthening exercises (10–12 wk) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (7) Technique: simple stitch repair Duration of immobilization: NR Duration of rehab: >24 mo Rehab components: passive stretching (1–4 wk); active-assisted stretching (4 wk); active stretching (6 wk); strengthening exercises (10–12 wk) Rehab regime: NR PRE-OP TREATMENT: yes Duration, min, mean (range): 6 mo, 19.1 mo (6 mo–2.8 yr) Type of treatment: exercise | HRQL: NR Function: • ASES (ADL) • UCLA Pain: • VAS ROM: • Forward motion Strength: NR Other: • Cuff integrity | No difference in clinical outcomes between massive cuff stitch or simple stitch, but massive cuff stitch was superior to simple stitch in repair integrity. |
| Ko SH, 2008 Country: South Korea Treatment category: Operative technique Questions: Q2, Q5 Funding: NR NOS: 5*/8* | Recruitment dates: Dec 2004 to Jan 2006 Study design: prospective cohort Enrolled consecutively: yes Followup duration, mean (range): 2.6 yr (2–3.1 yr) Inclusion criteria: med FTT Exclusion criteria: (1) sm, lg or mass RC tear, PTT; (2) impingement syndrome; (3) severe stiffness; (4) biceps subluxation tear; (5) mini-open/open repair; (6) double-row repair | Enrolled: 78 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, SC GROUP 1 N: NR Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: med Dominant shoulder %: NR Comorbidities: arthritis of AC joint (4); hypertrophied membrane GROUP 2 N: NR Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: med Dominant shoulder %: NR Comorbidities: arthritis of AC joint (3); synovial around cuff | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): lateral clavical excision (for AC arthritis) (4) Technique: modified mattress locking stitch (mean/range: 1.7/1–3 suture anchors; 3.3/2–6 sutures) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): lateral clavical excision (for AC arthritis) (3) Technique: simple stitch (mean/range: 1.8/1–3) suture anchors; (mean/range: 3.3/2–sutures) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: yes Duration (mean/range): 12 mo/3–33 mo Type of treatment: exercise | HRQL: NR Function: • ASES • UCLA Pain: • VAS ROM: NR Strength: NR Other: • cuff integrity | Arthroscopic repair of med sized FTT by use of modified mattress lock stitch improves patient satisfaction rates and radiographic repair integrity compared to simple stitch repair. |
| Köse KC, 2008 Country: Turkey Treatment category: Operative approach Questions: Q2, Q5, Q6 Funding: NR NOS: 5*/8* | Recruitment dates: 2001 to 2005 Study design: retrospective cohort Enrolled consecutively: NR Followup duration, mean (range): Group 1: 21.6 mo (12 mo–2.8 yr); Group 2: 2.6 yr (13 mo–6.8 yr) Inclusion criteria: (1) required RCR, (2) tear confirmed intraoperatively. Exclusion criteria: (1) <1 yr of followup, (2) no regular followup, (3) arthroscopically assisted mini-open repair, (4) traditional open repair cuff debridement + subacromial decompression without repair, (5) revision procedure, (6) concomitant stiffness | Enrolled: 57 Analyzed: 50 Withdrawals: 7 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 25 Age, mean±SD (range): 62±10 yr (32–75 yr) Males %: 16 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 25 Age, mean±SD (range): 55±7.6 yr (34–72 yr) Males %: 28 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching (up to wk 6); active stretching (wk 6) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching (up to wk 6); active stretching (wk 6) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS | HRQL: NR Function: • CMS •UCLA Pain: NR ROM: NR Strength: NR Other: NR | Clinical results are similar but have a higher cost for arthroscopic RCR compared with mini-open RCR. |
| Koubaa S, 2006 Country: Tunisia Treatment category: Non-operative Questions: Q3, Q5 Funding: NR BA Quality: Consecutive: U Followup: U Outcome assessment: U | Recruitment dates: Aug 2001 to Mar 2002 Study design: before-and-after Enrolled consecutively: NR Followup duration, (minimum): 6 mo Inclusion criteria: (1) rupture or perforation “transfixiante” degenerative of RC, (2) adherence to therapeutic protocol, (3) ≥6 mo followup Exclusion criteria: NR | Enrolled: 24 Analyzed: 24 Withdrawals: 0 Duration since symptom onset, mean±SD (range): 9.1±12.3 mo (3 mo–2.7 yr) Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+IS+SC GROUP 1 N: 24 Age, mean±SD (range): 59.2±10 yr (44–83 yr) Males %: 37.5 Cause of tear: degenerative (24) Tear size: mean: 13.5 mm2 Dominant shoulder %: 62.5 Comorbidities: NR | GROUP 1 Intervention: passive/active stretching, strengthening, corticosteroid injection, NSAIDs, analgesics, other PT techniques e.g., proprioception, re-education, ultrasound Drug name: analgesics, piroxicam Duration of treatment: 2 mo Treatment Regime: Frequency–3x/wk.; Intensity– NR Degree of supervision: NR Treatment provider: PT Additional comments: NA | HRQL: NR Function: • CMS • VAS (100 points) Pain: • VAS (100 point) • night pain ROM: • abduction (passive and active) • flexion (passive and active) • external rotation (active) • internal rotation Strength: NR Other: • number of pts returning to work • success • pt reported efficacy of tx | Study confirms the efficacy of nonoperative tx despite methodological limitations. Good results were achieved in 75% of patients (lasted 6 mo). Nonoperative tx should be offered as first option. |
| Kreuz PC, 2005 Country: Germany Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: U Followup: Y Outcome assessment: U | Recruitment dates: 1994 to 1999 Study design: before-and-after Enrolled consecutively: NR Followup duration, mean (range): 3 yr (2.3–4 yr) Inclusion criteria: isolated traumatic rupture of SC tendon Exclusion criteria: NR | Enrolled: 16 Analyzed: 16 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT (9); PTT (7) Tendon(s) torn: SC GROUP 1 N: 16 Age, mean±SD (range): 46 yr (27–64 yr) Males %: 87.5 Cause of tear: traumatic (16) Tear size: NR Dominant shoulder %: 93.8 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): manipulation (1) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching–NR; active-assisted stretching (wk 4); stretching (3 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration (mean/range): PTT (4.7 mo; 3–7 mo); FTT (0.9 mo; 0.25–2 mo) Type of treatment: PT NOS, NSAID | HRQL: NR Function: • CMS • Shld function rating Pain: • pain NOS ROM: NR Strength: NR Other: NR | Repair of FTT and PTT of SC tendon shows improvement in CMS. Delay between trauma and surgery was inversely proportional to the improvement in CMS. |
| Lafosse L, 2007 Country: France Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: 1999 to 2003 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 3 yr (2–4.8 yr) Inclusion criteria: (1) FTT ≥1 tendon, underwent repair with double-row technique, (2) followup ≥2 yr Exclusion criteria: (1) single-row repair, (2) open repair, (3) a contaminant SC tear, (4) refusal of having postop arthrogram, (5) follow up <2 yr | Enrolled: 95 (shld: 105) Analyzed: 95 (shld: 105) Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, SS+IS GROUP 1 N: 95 (shld: 105) Age, mean±SD (range): 52 yr (37–79 yr) Males %: 49.5 Cause of tear: NR Tear size: all sizes Dominant shoulder %: 72.4 Comorbidities: SC fraying (17) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures: acromioplasty (105); biceps tenotomy/tenodesis (59)/(50) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (day 1–wk 3); active stretching (≥wk 6); Modalities–hydrotherapy (encouraged) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS | HRQL: NR Function: • CMS Pain: • VAS ROM: • abduction • flexion (active) Strength: • mean strength Other: • cuff integrity | Much lower rate of failure can be achieved by arthroscopic RCR with use of the double-row suture anchor technique compared with previous reports of either open or arthroscopic repair methods. |
| Lafosse L, 2007 Country: France Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: May 2000 to Jul 2002 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 2.4 yr (2–3.3 yr) Inclusion criteria: pt with RC tear involving the SC tendon Exclusion criteria: RC tear involving other tendons | Enrolled: 17 Analyzed: 17 Withdrawals: 0 Duration since symptom onset, mean (range): 2 yr (3 mo–3.7 yr) Type of tear: FTT (15); PTT (2) Tendon(s) torn: SC GROUP 1 N: 17 Age, mean±SD (range): 47 yr (29–59 yr) Males %: 76.5 Cause of tear: degenerative (4), traumatic (13) Tear size: sm, med, lg Dominant shoulder %: 94.1 Comorbidities: rupture of LHB (2); partial tear of biceps tendon (7) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): biceps tenodesis (9) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (wk 6); active stretching (≥wk 6); strengthening (≥3 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • UCLA Pain: • VAS (15 points) ROM: • flexion • external rotation • internal rotation Strength: • strength (25 points) Other: • cuff integrity | Arthroscopic SC repair can result in durable RC repair with clinical results that are at least comparable with those open repair techniques. |
| LaStayo PC, 1998 Country: USA Treatment category: Post-op rehabilitation Questions: Q2, Q5, Q6 Funding: No funding ROB: High | Recruitment dates: 1991 to 1994 Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration, mean±SD (range): 22±9.8 mo (6 mo– 3.8 yr) Inclusion criteria: RCR Exclusion criteria: (1) mass, irreparable RC tear; (2) pre-op evidence of instability; (3) rheumatol disorder; (4) repetitive stress disorder; (5) fracture; (6) glenohumeral arthritis; (7) adhesive capsulitis; (8) previous surgery | Enrolled: 31 (shld: 32) Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: shld: 17 Age, mean±SD (range): 62.9 yr (30–80 yr) Males %: 47.1 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: 58.8 Comorbidities: NR GROUP 2 N: shld: 15 Age, mean±SD (range): 63.7 yr (45–75 yr) Males %: 40 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: 80 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: 6 wk Rehab components: in hospital: passive stretching (1–3 days); at home: CPM (day 3–4 wk); passive stretching (wk 4–6); active stretching (wk 4–6); strengthening (wk 10–1 yr) Rehab regime: Frequency –daily; Intensity–4 hr/day GROUP 2 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: 6 wk Rehab components: in hospital: passive stretching (1–3 days); at home: passive stretching (day 3–wk 6); active stretching (wk 6–10).; strengthening (wk 10–1 yr) Rehab regime: Frequency–3x/day; Intensity–3 sets, 10–15 reps PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • SPADI Pain: • VAS ROM: • flexion (passive and active) • external rotation (passive and active) Strength: • flexion • external rotation Other: • number of outpt physical therapist visits | CPM results in little disability and excellent or good outcome after repair. It does not provide a better outcome than manual passive ROM exercises, which is more cost effective. |
| Leroux JL, 1993 Country: France Treatment category: Nonoperative Questions: Q3 Funding: NR NOS: 3*/8* | Recruitment dates: NR Study design: Retrospective cohort Enrolled consecutively: yes Followup duration, mean (range): 114.4 days (5 days– 2 yr) Inclusion criteria: NR Exclusion criteria: NR | Enrolled: 112 (shld: 115) Analyzed: 60 Withdrawals: 52 Duration since symptom onset, mean±SD (range): 7.5±0.5 mo (NR) Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+SC GROUP 1 N: 18 Age, mean±SD (range): all groups: 61.5 yr (36–85 yr) Males %: all groups 60.7 Cause of tear: NR Tear size: NR Dominant shoulder %: all groups 70 Comorbidities: all groups: pseudoparalytic shld (6%) GROUP 2 N: 42 Age, mean±SD (range): see group 1 Males %: see group 1 Cause of tear: NR Tear size: NR Dominant shoulder %: see group 1 Comorbidities: see group1 | GROUP 1 Intervention: PT NOS, corticosteroid injection Drug name: NR Duration of treatment: NA Treatment Regime: Frequency–NR; Intensity–(mean±SD) 1.9±0.6 injections Degree of supervision: NR Treatment provider: NR GROUP 2 Intervention: PT NOS, corticosteroid injection Drug name: NR Duration of treatment: (mean/range) 16 day/5 day–3 mo Treatment Regime: Frequency–NR; Intensity–(mean±SD) 1.6±0.1 injections Degree of supervision: NR Treatment provider: NR | HRQL: NR Function: • Scapular function Index Pain: NR ROM: NR Strength: NR Other: NR | Significantly higher functional improvement was obtained in patients receiving rehabilative tx than those who were not. This confirms the beneficial effect of rehabilitative therapy in RC tears. |
| Levy O, 2008 Country: UK Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: U Outcome assessment: U | Recruitment dates: Oct 1998 to May 2003 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 3.0 yr (2–6.1 yr) Inclusion criteria: RC tears + undergoing arthroscopic repair Exclusion criteria: lost to followup | Enrolled: 115 Analyzed: 102 Withdrawals: 13 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: SS+IS+SC GROUP 1 N: 115 Age, mean±SD (range): 57.3 yr (23–78 yr) Males %: 55.7 Cause of tear: degenerative (54), traumatic (48) Tear size: all sizes Dominant shoulder %: NR Comorbidities: biceps pathology (15) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (99); biceps tenotomy/tenodesis (12); manipulation (all); resection arthroplasty of joint (41) Duration of immobilization: 6 wk. Duration of rehab: 6 mo (min) Rehab components: passive stretching (up to wk 6); active stretching and strengthening (wk 6 onward) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: • number of pts able to return to work/leisure activities • cuff integrity | There was a significant improvement in the mean pre- operative CMS after repair of RC tears. Higher score for: (1) intact repair in comparison with recurrent tears, (2) small tears with arthroscopic repair of RC tears leads to higher rates of satisfaction and good functional results. |
| Levy O, 2008 Country: UK Treatment category: Non-operative Questions: Q3, Q6 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: U | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: NR Followup duration, (minimum): 9 mo Inclusion criteria: (1) mass irreparable RC tears, (2) severely medially retracted (grade 3) Exclusion criteria: NR | Enrolled: 17 Analyzed: 17 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS GROUP 1 N: 17 Age, mean±SD (range): 80 yr (70–96 yr) Males %: 35.3 Cause of tear: degenerative (17) Tear size: mass Dominant shoulder %: NR Comorbidities: pseudo paralysis (all); multiple medical comorbidities (all) | GROUP 1 Intervention: strengthening, corticosteroid injection, NSAIDs, PT NOS Drug name: Marcaine 0.5%; Depomedrone Duration of treatment: 12 wk (min) Treatment Regime: Frequency–3-5 x/day (first 6 wk); Intensity–Marcaine 10 mg, Depomedrone 40 mg Degree of supervision: NR Treatment provider: PT | HRQL: NR Function: • CMS Pain: NR ROM: • flexion Strength: NR Other: NR | A structured deltoid rehabilitation program is suitable for massive RC tears in elderly pts. |
| Lichtenberg S, 2006 Country: Germany Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: U Outcome assessment: U | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 2.2 yr (NR) Inclusion criteria: FTT of SS tendon Exclusion criteria: (1) IS/SC tears; (2) PTT, partial repairs; (3) adhesive capsulitis; (4) glenohumeral arthritis; (5) upward migration of the head of the humerus, severe muscle atrophy or fatty infiltration | Enrolled: 53 Analyzed: 53 Withdrawals: 0 Duration since symptom onset, mean (range): 11.7 mo (1 mo–6 yr) Type of tear: FTT Tendon(s) torn: SS GROUP 1 N: 53 Age, mean±SD (range): 60.9 yr (46–74 yr) Males %: 64.2 Cause of tear: NR Tear size: NR Dominant shoulder %: 69.8 Comorbidities: biceps pathology (18) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (52); biceps tenotomy/tenodesis (18) resection of lateral clavicle (14) Duration of immobilization: 3 wk Duration of rehab: 4 mo (min) Rehab components: passive stretching (day 1–wk 6); active stretching (NR); stretching (min 4 mo); hydrotherapy (NR) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: • cuff integrity | Arthroscopic repair with subacromial decompression gives good clinical and subjective results, comparable to open or mini-open repair results. Pts over the age of 65 yr show a higher retear rate. |
| Liem D, 2007 Country: Germany Treatment category: Operative approach Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: Jan 2000 to Aug 2003 Study design: retrospective cohort Enrolled consecutively: yes Followup duration, (endpoint): group 1: 25 mo.; group 2: 17.6 mo. Inclusion criteria: isolated SS tear with persistent pain and reduced function Exclusion criteria: (1) previous surgery; (2) major trauma including dislocation or fracture; (3) concomitant adhesive capsulitis; grade 3 atrophy | Enrolled: 77 Analyzed: 38 Withdrawals: 39 Duration since symptom onset, mean±SD (range): Group 1: 10.6±7.9 mo (NR); Group 2: 9.6±5.2 mo (NR) Type of tear: NR Tendon(s) torn: SS GROUP 1 N: 24 Age, mean±SD (range): 62.9±6.7 yr (NR) Males %: 66.7 Cause of tear: degenerative (13), traumatic (6) Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: SLAP lesion (1) GROUP 2 N: 53 Age, mean±SD (range): 61.9±6.6 yr (NR) Males %: 30.2 Cause of tear: degenerative (9), traumatic (10) Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: SLAP lesion (2) | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (18); labral repair (1); biceps tenodesis/tenotomy (2)/(1); AC joint resection (4) Duration of immobilization: 48 hr. Duration of rehab: NR Rehab components: passive stretching (day 1–wk 6); active stretching (≥wk 7); strengthening (wk 9–12) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); labral tear (2); biceps tenotomy (5); AC joint resection (6) Duration of immobilization: 48 hr. Duration of rehab: NR Rehab components: passive stretching (day 1–wk 6); active stretching (≥wk 7); strengthening (wk 9–12) Rehab regime: NR PRE-OP TREATMENT: YES Duration: NR Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: • CMS Pain: NR ROM: • abduction • external rotation • flexion Strength: NR Other: • cuff integrity | In isolated SS tears, arthroscopic RC repair produces excellent clinical results and equivalent tendon integrity compared with mini-open repair. |
| Lim JTK, 2005 Country: England Treatment category: Operative Questions: Q2 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: NR Study design: prospective cohort treated as before-and-after Enrolled consecutively: yes Followup duration, mean (range): 14 mo (3–24 mo) Inclusion criteria: (1) sympromatic >6 mo; (2) failed nonoperative tx; (3) impingement syndrome with/without tear Exclusion criteria: (1) instability; (2) no impinge; (3) injection test in another unit; (4) FTT with proximal humeral migration tx nonoperatively or with open RCR | Enrolled: 23 Analyzed: 23 Withdrawals: 0 Duration since symptom onset, minimum (range): 6 mo (NR) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 19 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 4 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: NA Additional procedures (N): acromioplasty (all); excision of AC joint (52) Duration of immobilization: 3–5 day Duration of rehab: NR Rehab components: passive stretching (immediately post-operative); stretching NOS (NR) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: NA Additional procedures (N): acromioplasty (all); excision of AC joint (10) Duration of immobilization: 3–5 day Duration of rehab: NR Rehab components: passive stretching (immediately post-operative); stretching NOS (NR) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: cortisone injection | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: NR | Substantial improvement of CMS following decompression in patients with FTT with predominant symptoms of impingement. No patients went on to further surgery. |
| Lunn JV, 2008 Country: France Treatment category: Nonoperative vs. operative Questions: Q4, Q5 Funding: NR NOS: 5*/8* | Recruitment dates: 1998 to 2004 Study design: prospective cohort Enrolled consecutively: NR Followup duration, mean (range): 4.2 yr (2–6.6 yr) Inclusion criteria: isolated IS rupture and characteristic edema pattern of IS muscle on MRI Exclusion criteria: No other FTT of RC, no bilateral disease | Enrolled: 19 Analyzed: 19 Withdrawals: 0 Duration since symptom onset, mean (range): 4.3 yr (6 mo–10 yr) Type of tear: FTT Tendon(s) torn: IS GROUP 1 N: 14 Age, mean±SD (range): 47.1 yr (30–66 yr) Males %: 7.1 Cause of tear: degenerative (13), traumatic (1) Tear size: NR Dominant shoulder %: 57.1 Comorbidities: all groups: SS tendinitis (4); partial SS tear (3) GROUP 2 N: 5 Age, mean±SD (range): 46.2 yr (38–59 yr) Males %: 60 Cause of tear: degenerative (4), traumatic (1) Tear size: NR Dominant shoulder %: 60 Comorbidities: see group1 | GROUP 1 Intervention: corticosteroid injection, PT NOS, activity modification Drug name: NR Duration of treatment: NR Treatment Regime: NR Degree of supervision: NR Treatment provider: NR GROUP 2 Surgical approach: open Type of surgery: repair Additional procedures: NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: yes Duration: (mean/range) 2.3 injections/0–5 injection Type of treatment: injections | HRQL: NR Function: • CMS Pain: NR ROM: • flexion (active) • external rotation • internal rotation Strength: NR Other: • degree of fatty muscle infiltration • cuff integrity | Comparing the gain in the CMS, there was no significant benefit between those treated operatively and nonoperatively. |
| Maier D, 2007 Country: Germany Treatment category: Operative Questions: Q2, Q5 Funding: No funding BA Quality: Consecutive: U Followup: Y Outcome assessment: Y | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: NR Followup duration, mean (range): 2.4 yr (2–4.5 yr) Inclusion criteria: (1) written informed consent, (2) instability of gross intact LHB tendon, (3) FTT of SC tendon, (4) >24 mo followup Exclusion criteria: (1) no trauma to cause the injury, (2) pathological changes in LHB tendon at the time of surgery, (3) posterior RC tear, (4) atrophy of SC muscle, (5) ≥10 wk since injury | Enrolled: 21 Analyzed: 21 Withdrawals: 0 Duration since symptom onset, mean (range): 6.2 wk (3–9 wk) Type of tear: NR Tendon(s) torn: SS, SC GROUP 1 N: 21 Age, mean±SD (range): 51 yr (30–70 yr) Males %: 76.2 Cause of tear: traumatic (21) Tear size: sm Dominant shoulder %: NR Comorbidities: anterior inferior shld dislocation (traumatic) (4) | GROUP 1 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): NR Duration of immobilization: 6 wk Duration of rehab: 3 mo Rehab components: passive stretching (day 1); active-assisted stretching (individualized); active stretching (wk 6); strengthening (≥wk 6) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • subjective shld function Pain: NR ROM: NR Strength: NR Other: NR | Stabilization of the LHB tendon in early repair of a traumatic tear of the SC tendon has functional outcomes comparable with the result of tenodesis or tenotomy reported in previous studies. |
| Mallon WJ, 2004 Country: USA Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: Jan 1990 to May 1993 Study design: retrospective cohort treated as before-and-after Enrolled consecutively: yes Followup duration, (minimum): 1 yr Inclusion criteria: open repair of chronic FTT Exclusion criteria: chronic mass tears | Enrolled: 224 Analyzed: 224 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 95 Age, mean±SD (range): 51.8±6.4 yr (NR) Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 129 Age, mean±SD (range): 53.1±9 yr (NR) Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 4–6 wk Duration of rehab: 12 mo Rehab components: passive stretching (day 3–wk 6); active-assisted stretching (wk 6); strengthening (3 mo–1 yr) Rehab regime: NR GROUP 2 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 4–6 wk Duration of rehab: 12 mo Rehab components: passive stretching (day 3–wk 6); active-assisted stretching (wk 6); strengthening (3 mo–1 yr) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • UCLA Pain: • VAS ROM: NR Strength: NR Other: NR | Non-smokers undergoing RCR have greater improvement of pain and better functional results than smokers. |
| Marc T, 2009 Country: France Treatment category: Post-op rehabilitation Questions: Q2, Q6 Funding: NR NOS: 6*/8* | Recruitment dates: 2004 Study design: Retrospective cohort Enrolled consecutively: NR Followup duration, mean (range): 2 yr Inclusion criteria: (1) FT RC repair by one of the authors (2) seen ≥2 years postoperatively Exclusion criteria: NR | Enrolled: 80 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, IS, SC Age, mean±SD (range): 61 yr (36–80) Males %: 61 GROUP 1 N: 26 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 38 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR GROUP 3 N: 16 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: NR Type of surgery: repair Additional procedures (N): NR Duration of immobilization: 3–8 wk, depending on surgical intervention Duration of rehab: 4–10 wk Rehab components: kinébalnéotherapie; kinésithérapie; ergothérapie; physical therapy Rehab regime: NR GROUP 2 Surgical approach: NR Type of surgery: repair Additional procedures (N): NR Duration of immobilization: 3–8 wk, depending on surgical intervention Duration of rehab: 3–4 mo Rehab components: Concept Global d’Epaule (CGE); 3 principles: 1) movements done with ext post-int pressure on humeral head to increase subacromial space; 2) gradual progression from passive to active movement at patient’s tolerance; 3) restore dynamic equilibrium between muscle responsible fore elevating humeral head and rotation cuff muscles Rehab regime: NA GROUP 3 Surgical approach: NR Type of surgery: repair Additional procedures (N): NR Duration of immobilization: 3–8 wk, depending on surgical intervention Rehabilitation: Initially, following Group 1 protocol; subsequently, received CGE following Group 2 treatment protocol. PRE-OP TREATMENT: yes Duration: NR Type of treatment: exercise | HRQL: NR Function: • CMS Pain: • VAS ROM: NR Strength: • Strength (NR) Other: NR | Functional outcome was the same for inpatient and outpatient rehab; pain reduction was greater for patients with outpatient rehab. |
| Matis N, 2006 Country: Austria Treatment category: Operative technique Questions: Q2, Q5 Funding: NR NOS: 4*/8* | Recruitment dates: 1998 to 2003 Study design: prospective cohort Enrolled consecutively: No Followup duration, mean (range): Group 1: 26.8 mo (5–59 mo); Group 2: 14.3 mo (5–33 mo) Inclusion criteria: (1) SS and IS tendon tears (total, PTT), (2) <75 yr old, (3) mobilized tendon Exclusion criteria: (1) retracted tendon cannot be sufficiently mobilized to provide a tension free reinsertion, (2) SC tear, (3) extremely high head of humerus, (4) atrophy of RC muscle ≥50% on MRI, (5) pts >75 yr | Enrolled: 99 Analyzed: 96 Withdrawals: 3 Duration since symptom onset, mean (range): NR Type of tear: FTT (NR); PTT (NR) Tendon(s) torn: SS, IS GROUP 1 N: 75 Age, mean±SD (range): 58.2 yr (35–75 yr) Males %: 68 Cause of tear: NR Tear size: sm, med Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 24 Age, mean±SD (range): 58 yr (35–75 yr) Males %: 66.7 Cause of tear: NR Tear size: sm, med Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all) Technique: single transoseous suture; central mattress Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive and active stretching; Modality–heat/cold; electrotherapy; under water tx; lymph drainage Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all) Technique: central mattress suture Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive and active stretching; Modality–heat/cold; electrotherapy; under water tx; lymph drainage Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: • cuff integrity | Arthroscopic RC reinsertion provides comparable results to open refixation, after allowing for an appropriate learning curve, with less surgical trauma and faster recovery. |
| McBirnie JM, 2005 Country: Scotland Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: U | Recruitment dates: Apr 1995 to Apr 1998 Study design: before-and-after Enrolled consecutively: NR Followup duration, mean (range): 2.4 yr (2–5 yr) Inclusion criteria: presence of mobile, FTT Exclusion criteria: (1) non-mobilized irreparable tears, (2) PTT, (3) previous shld surgery | Enrolled: 53 Analyzed: 53 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 53 Age, mean±SD (range): 51 yr (23–74 yr) Males %: 71.7 Cause of tear: NR Tear size: sm/med, lg/mass, mean: 2.5 cm Dominant shoulder %: 62.3 Comorbidities: SLAP lesion total (33); SLAP lesion type I (22); SLAP lesion type II (11); biceps tenodesis (1) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); labral repair (33); biceps tenotomy/tenodesis (1); distal clavical resection (NR) Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching (wk 3); active stretching and strengthening (wk 6); physical therapy (6 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: • SF-36 Function: • ASES • CMS Pain: NR ROM: NR Strength: NR Other: NR | Use of bioabsorbable tacks for arthroscopic repair produced satisfactory clinical outcome results. |
| McCallister WV, 2005 Country: USA Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: N Outcome assessment: N | Recruitment dates: Nov 1992 to Dec 2000 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean±SD (range): 5.5±2.2 yr (2–10 yr) Inclusion criteria: FTT Exclusion criteria: (1) irreparable RC tear; (2) previous RC or acromial surgery, or PTT; (3) WCB claim | Enrolled: 96 Analyzed: 61 Withdrawals: 35 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+IS+SC GROUP 1 N: 96 Age, mean±SD (range): 61±11 yr (30–84 yr) Males %: 43.8 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): bursectomy (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: • SF-36 Function: • SST Pain: NR ROM: NR Strength: NR Other: NR | Open RCR without acromioplasty showed improvement in self-assessed shoulder comfort. |
| McIntyre LF, 2006 Country: USA Treatment category: Operative technique Questions: Q2, Q5 Funding: NR NOS: 4*/8* | Recruitment dates: Jan 2001 to Feb 2002 Study design: retrospective cohort Enrolled consecutively: yes Followup duration, mean (range): 2.3 yr (18 mo–3.3 yr) Inclusion criteria: NR Exclusion criteria: NR | Enrolled: 105 Analyzed: 87 Withdrawals: 18 Duration since symptom onset, mean (range): Group 1: 9.9 mo (1 mo–3 yr); Group 2: 10.4 mo (1 mo–3 yr) Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 50 Age, mean±SD (range): 55.7 yr (37–78 yr) Males %: 58 Cause of tear: degenerative (26), traumatic (24) Tear size: mean: 3.4 cm; range:1–6 cm Dominant shoulder %: 62 Comorbidities: adhesive capsulitis GROUP 2 N: 55 Age, mean±SD (range): 54.7 yr (17–78 yr) Males %: 69.1 Cause of tear: degenerative (30), traumatic (25) Tear size: mean: 3.0 cm; range: 1–6 cm Dominant shoulder %: 65.5 Comorbidities: NR | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (4); glenohumeral arthritis debridement (1); SLAP lesion excision (1); calcified tendonitis excision (1); arthroscopic capsular release (1) Technique: metalic suture anchor; monofilament stitch and tendon to bone closure Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching (wk 1); active stretching (wk 4–6) Rehab regime: NR GROUP 2 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (all) Technique: hand tied knots; braided polyester suture; simple stitch Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching (wk 1); active stretching (wk 4–6) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • UCLA Pain: NR ROM: NR Strength: NR Other: NR | No statistical difference in post operative UCLA score between the 2 groups. |
| Michael JWP, 2005 Country: Germany Treatment category: Post-op rehabilitation Questions: Q2, Q5 Funding: Industry Other: German ROB: High | Recruitment dates: NR Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration (endpoint): 56 days Inclusion criteria: (1) 30–70 yr, (2) FTT of SS, (3) acromiohumeral space >7 mm, (4) attend followup visits, (5) consent Exclusion criteria: (1) previous surgery, (2) shld co-morbidity, (3) ability to use CPM device at home, (4) paralysis, (5) Parkinson’s disease, (6) adhesive capsulitis, (7) mental health condition, (8) neurological damage, (9) SC rupture | Enrolled: 61 Analyzed: 55 Withdrawals: 6 Duration since symptom onset, mean (range): NR Type of tear: FTT (53); PTT (8) Tendon(s) torn: SS GROUP 1 N: 40 Age, mean±SD (range): 58 yr (35–70 yr) Males %: 62.5 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 21 Age, mean±SD (range): 58 yr (43–71 yr) Males %: 57.1 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open (19); mini-open (14); other (1) Type of surgery: repair Additional procedures (N): manipulation (4): setting fractures (1) Duration of immobilization: NR Duration of rehab: 90 days Rehab components: CPM (day 1/3– 42); passive stretching (day 1–3); active-assisted stretching (day 3–wk 3); active and active-assisted stretching and strengthening (wk 4–6); strengthening (≥wk 7); Modality–cold Rehab regime: Frequency– CPM, 5x/day; PT 2x/wk; Intensity–CPM, 20 min. each; PT, 30 min/session GROUP 2 Surgical approach: open (12); mini-open (9); all-arthorscopic (4) Type of surgery: repair Additional procedures (N): manipulation (1); setting fractures (1) Duration of immobilization: 4 wk Duration of rehab: 90 days Rehab components: passive stretching (day 1–3); active-assisted stretching (day 3–wk 3); active and active-assisted stretching and strengthening (wk 4–6); strengthening (≥wk 7); Modality–cold Rehab regime: Frequency– 2x/wk; Intensity–30 min/session PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: • VAS (100 points) ROM: • time to 90° active abduction Strength: NR Other: • time away from work | Postoperative tx of FTT with combined CPM and physical therapy protocol provided a significantly earlier ROM than physical therapy alone. |
| Milano G, 2007 Country: Italy Treatment category: Operative approach Questions: Q2, Q6 Funding: NR ROB: High | Recruitment dates: NR Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration (endpoint): 2 yr Inclusion criteria: (1) reparable FTT, (2) type 2 or 3 acromion Exclusion criteria: (1) PTT or irreparable tear; (2) labral pathology amenable to surgical repair; (3) type 1 acromion, os acromium, degenerative arthritis of glenohumeral joint; (4) symptomatic arthritis of AC joint; (5) RC arthropathy; (6) previous surgery; (7) WCB claim | Enrolled: 80 Analyzed: 71 Withdrawals: 9 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, SS+IS+SC GROUP 1 N: 40 Age, mean±SD (range): 61±7 yr (NR) Males %: 50 Cause of tear: NR Tear size: NR Dominant shoulder %: 57.5 Comorbidities: pathology of LHB (12) GROUP 2 N: 40 Age, mean±SD (range): 59.7±9.7 yr (NR) Males %: 47.5 Cause of tear: NR Tear size: NR Dominant shoulder %: 60 Comorbidities: pathology of LHB (20) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy (7)/tenodesis (14) Duration of immobilization: 3 wk. Duration of rehab: NR Rehab components: stretching (passive, active, active-assisted) (wk 4– 8); strengthening (wk 9–12); open kinetic chain exercise, proprioception and polymetric exercises, postural rehab of kinetic chain (wk 13–16) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): biceps tenotomy (15)/tenodesis (5); subacromial bursectomy (all) Duration of immobilization: 3 wk. Duration of rehab: NR Rehab components: stretching (passive, active, active-assisted) (wk 4– 8 wk); strengthening (wk 9–12); open kinetic chain exercise, proprioception and polymetric exercises, postural rehab of kinetic chain (wk 13–16) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • DASH • Work-DASH Pain: NR ROM: NR Strength: NR Other: NR | At short-term followup subacromial decompression did not seem to significantly affect the outcome of arthroscopic RCR. |
| Millar NL, 2009 Country: Australia Treatment category: Operative approach/technique Questions: Q2, Q5, Q6 Funding: Industry NOS: 7*/8* | Recruitment dates: Feb 2003 to Mar 2006 Study design: Retrospective cohort Enrolled consecutively: yes Followup duration, mean (range): 2 yr Inclusion criteria: (1) symptomatic RC tears Exclusion criteria: (1) glenohumeral arthritis (2) fracture, (3) previous shoulder surgery, (4) osteonecrosis, (5) PTT, (6) unable/unwilling to undergo ultrasound at 6 mo and 2 yr post-op, (7) repairs within the first 6 wk of surgeon changing to new arthroscopic technique | Enrolled: 159 Analyzed: 87 Withdrawals: 72 Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 20 Age, mean±SD (range): 58 yr (28–87) Males %: 50 Duration since symptom onset, mean (range): 15 mo (0.7 mo–6.8 yr) Cause of tear: NR Tear size: all sizes Dominant shoulder %: 60 Comorbidities: NR GROUP 2 N: 29 Age, mean±SD (range): 64 yr (40–90 yr) Males %: 34 Duration since symptom onset, mean (range): 7.2 mo (1–3.3 yr) Cause of tear: NR Tear size: all sizes Dominant shoulder %: 66 Comorbidities: NR GROUP 3 N: 38 Age, mean±SD (range): 59 yr (34–86) Males %: 53 Duration since symptom onset, mean (range): 6.6 mo (0.5 mo–2.6 yr) Cause of tear: NR Tear size: all sizes Dominant shoulder %: 76 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (day 1); active stretching and strengthening exercises (6 wk); active overhead activity (3 mo) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Technique: knotted Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (day 1); active stretching and strengthening exercises (6 wk); active overhead activity (3 mo) Rehab regime: NR GROUP 3 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Technique: knotless Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (day 1); active stretching and strengthening exercises (6 wk); active overhead activity (3 mo) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES (1o) • Overall shoulder function • RC Functional Index Pain: • At rest (0–4) • At night (0–4) ROM: • flexion • abduction • external rotation Strength: • supraspinatus • external rotation • liftoff Other: • cuff integrity | Open or arthroscopic repair of RC tear resulted in improvements in pain, motion, strength and function. Arthroscopic had 20 percent better ASES scores than the open group. |
| Milroy DR, 2008 Country: USA Treatment category: Post-op rehabilitation Questions: Q2 Funding: NR Other: Abstract NOS: 3*/8* | Recruitment dates: NR Study design: retrospective cohort Enrolled consecutively: NR Followup duration, mean (range): NR Inclusion criteria: NR Exclusion criteria: NR | Enrolled: 67 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 28 Age, mean±SD (range): 57±10.9 yr (NR) Males %: 57.1 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 39 Age, mean±SD (range): 57.8±9.81 yr (NR) Males %: 69.2 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: NR Type of surgery: repair Additional procedures: NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 2 Surgical approach: NR Type of surgery: repair Additional procedures: NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: • DASH Function: NR Pain: NR ROM: NR Strength: NR Other: • number of tx visits | Tx of patients with a standardized care process following RCR resulted in greater functional improvement and utilized fewer physical therapy visits. |
| Misamore GW, 1995 Country: USA Treatment category: Operative Questions: Q2, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: 1988 to 1990 Study design: retrospective cohort treated as before- and-after Enrolled consecutively: yes Followup duration, mean (range): 3.8 yr (2–5.7 yr) Inclusion criteria: (1) operative RCR, (2) active with no serious medical illness, (3) no response to nonoperative Exclusion criteria: (1) mass RC tear, (2) not amenable to direct primary repair, (3) treated with debridement alone or with a procedure involving local tissue augmentation | Enrolled: 103 (shld: 107) Analyzed: 103 (shld: 107) Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 24 Age, mean±SD (range): 53 yr (22–67 yr) Males %: 75 Cause of tear: NR Tear size: all sizes Dominant shoulder %: 50 Comorbidities: NR GROUP 2 N: 79 (shld: 83) Age, mean±SD (range): 53 yr (30–68 yr) Males %: 70.1 Cause of tear: NR Tear size: all sizes Dominant shoulder %: 64.6 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (≥day 1); active stretching (wk 6–8); strengthening (wk 8–9) Rehab regime: NR GROUP 2 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (≥day 1); active stretching (wk 6–8); strengthening (wk 8–9) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (mean) Type of treatment: exercise, physical therapy NOS, cortisone injection | HRQL: NR Function: • UCLA Pain: NR ROM: NR Strength: NR Other: • number of pts returning to work/sports | Workers compensation patients had poorer functional and return to work results than patients not receiving compensation, with the exception of the active ROM results. |
| Mohtadi NG, 2008 Country: Canada Treatment category: Operative approach Questions: Q2, Q5, Funding: Government, academic, foundation ROB: High | Recruitment dates: 1999 to 2004 Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): 2 yr (NR) Inclusion criteria: (1) unremitting pain, (2) ≥3 mo nonoperative, (3) weakness, (4) >18 yr, (5) FTT, (6) English speaking Exclusion criteria: (1) <grade 3 muscle strength, (2) previous surgery, (3) PTT or irreparable tear | Enrolled: 73 Analyzed: 60 Withdrawals: 14 Duration since symptom onset, mean (range): >3 mo (NR) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 37 Age, mean±SD (range): 56.2 yr (44–77 yr) Males %: 59.5 Cause of tear: NR Tear size: all sizes Dominant shoulder %: 43.2 Comorbidities: NR GROUP 2 N: 36 Age, mean±SD (range): 57 yr (33–82 yr) Males %: 55.6 Cause of tear: NR Tear size: all sizes Dominant shoulder %: 66.7 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (immediately); active stretching (wk 6); CPM (≥wk 8) Rehab regime: NR GROUP 2 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (immediately); active stretching (6 wk); CPM (≥wk 8) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: NR | HRQL: • RC-QOL Function: • ASES • Shoulder Rating Questionnaire Pain: NR ROM: • flexion • external rotation at side • external rotation at 90° abduction • internal rotation Strength: • Function Shoulder Elevation Test Other: NR | No difference in outcomes at 1 and 2 years between mini-open and open acromioplasty. Statistically and clinically significant improvement in quality of life was found in mini- open patients at 3 mo vs. open RCR pts. |
| Montgomery TJ, 1994 Country: USA Treatment category: Operative approach Questions: Q2, Q5 Funding: NR ROB: High | Recruitment dates: Jan 1987 to Mar 1990 Study design (trial type): CCT (parallel) Enrolled consecutively: yes Followup duration, mean (range): NR (2–5 yr) Inclusion criteria: (1) failure of nonoperative tx, (2) FTT Exclusion criteria: NR | Enrolled: 106 (shld: 107) Analyzed: 87 (shld: 88) Withdrawals: 19 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 58 Age, mean±SD (range): 58±11.6 yr (32–79 yr) Males %: NR Cause of tear: NR Tear size: all sizes Dominant shoulder %: all groups 60.4 Comorbidities: NR GROUP 2 N: 49 Age, mean±SD (range): 60±12.2 yr (36–79 yr) Males %: NR Cause of tear: NR Tear size: all sizes Dominant shoulder %: see group 1 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching– day 10–30; active rehabilitation >1 mo Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: debridement Additional procedures (N): acromioplasty (all); abrasion of the greater tuberoscity (NR) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (day 10–30); active rehabilitation (>1 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: exercise, physical therapy NOS, cortisone injection, NSAID, avoidance of pain inducing activities | HRQL: NR Function: NR Pain: NR ROM: NR Strength: • abduction strength • external rotation strength Other: NR | Open repair group did significantly better than arthroscopic debridement group. Although arthroscopic tx may be indicated in select patients, this study could not delineate any factors that would allow pre-operative selection of these patients and therefore would recommend RCR for patients with FTT. |
| Moosemayer S, 2010 Country: Norway Treatment category: Nonoperative vs. operative Questions: Q1, Q4, Q5 Funding: NR ROB: High | Recruitment dates: Sept 2004 to Oct 2007 Study design: RCT (parallel) Enrolled consecutively: NR Followup duration, mean (range): 12 mo Inclusion criteria: (1) pain at rest or exercise laterally on the shoulder, (2) a painful arch, (3) positive impingement signs and a passive ROM ≥140 for abduction and flexion, (4) FTT <3 cm confirmed by MRI or US, (5) muscle atrophy <stage 2 on MRI, (6) traumatic and atraumatic tears Exclusion criteria: (1) age <18 years, (2) tears with absolute indication for surgery, (3) other local or systemic disease influencing shld function, (4) history of tendon surgery, (5) medical contraindication | Enrolled: 103 Analyzed: 102 Withdrawals: 1 Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+SC GROUP 1 Duration since symptom onset, mean±SD: 12.3±18.7 N: 51 Age, mean±SD (range): 59±7.5 yr Males %: 73 Cause of tear: degenerative (22); traumatic (30) Tear size: sm, med Dominant shoulder %: 65 Comorbidities: NR GROUP 2 Duration since symptom onset, mean±SD: 9.8±9.8 N: 51 Age, mean±SD (range): 61±7.6 yr Males %: 71 Cause of tear: degenerative (22); traumatic (29) Tear size: sm, med Dominant shoulder %: 61 Comorbidities: NR GROUP 3 N: 9 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: sm, med Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open (n=42); mini- open (n=9) Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all), biceps tenodesis (18) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (1 wk); active-assisted stretching (6 wk); strengthening exercises (12 wk) Rehab regime: NR Treatment provider: PT GROUP 2 Intervention: PT – stretching, strengthening and joint mobilization exercise Drug name: NR Duration of treatment: mean (range): 24 (9–55) training sessions Treatment Regime: Frequency – 2×/wk; Intensity – 40 mins/session Degree of supervision: direct (1:1) Treatment provider: PT GROUP 3 Initial mean of 24 sessions (range 15–34 session) of nonoperative treatment – see “Group 2” After failed improvement – see “Group 1” PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: • SF-36 Function: • ASES • CMS Pain: NR ROM: NR Strength: NR Other: • cuff integrity | In a short-term prospective study, nonoperative and operative interventions can be used for treatment of patients with small and medium-sized RCR. However, better results can be expected after primary surgical repair. |
| Moser M, 2007 Country: USA Treatment category: Operative approach Questions: Q2, Q5 Funding: NR NOS: 3*/8* | Recruitment dates: 1991 to 1999 Study design: retrospective cohort Enrolled consecutively: NR Followup duration (endpoint): 2 yr Inclusion criteria: (1) tear ≥5 cm with ≥2 tendons involved, (2) failure of nonoperative tx, (3) no prior repair, (4) minimal/no arthritis, (5) follow up ≥24 mo Exclusion criteria: NR | Enrolled: 38 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR ALL GROUPS N: 21 (group 1), 11 (group 2), 6 (group 3) Age, mean±SD (range): all groups: 62.6 yr (33–81 yr) Males %: 73.7 (all) Cause of tear: NR Tear size: mass Dominant shoulder %: 63.6 (all) Comorbidities: NR | ALL GROUPS Surgical approach: open Type of surgery: repair (group 1 and 2); debridement (group 3) Additional procedures (N): acromioplasty (NR) Duration of immobilization: NR Duration of rehab: >3 mo Rehab components: passive stretching (day 1–wk 6); active stretching (wk 6–3 mo); strengthening (≥3 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: NR Function: • SPADI Pain: NR ROM: • scaption (active) • internal rotation (active) • external rotation (active) Strength: • scaption • external rotation Other: NR | Pts with partial or complete repair were seen to have the best subjective and objective outcome measures, but due to sample size did not reach statistical significance, except active external rotation. Author will continue to tx mass tears with partial or complete repair over debridement. |
| Motycka T, 2004 Country: Austria Treatment category: Operative approach Questions: Q2, Q5 Funding: NR NOS: 4*/8* | Recruitment dates: 1988 to 1998 Study design: retrospective cohort Enrolled consecutively: NR Followup duration, mean±SD (range): 5 yr.±8 mo (2.1–14.2 yr) Inclusion criteria: RC tears ≥3 cm Exclusion criteria: NR | Enrolled: 76 Analyzed: 64 Withdrawals: 12 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 33 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: lg, mass Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 31 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: lg, mass Dominant shoulder %: NR Comorbidities: chronic rupture of LHB (3) | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all); resection of clavicle (1) Duration of immobilization: 3–6 wk Duration of rehab: NR Rehab components: passive stretching; active stretching; strengthening Rehab regime: NR GROUP 2 Surgical approach: open (15); all- arthorscopic (16) Type of surgery: debridement Additional procedures (N): acromioplasty (all); partial closure (8); resection of clavicle (1) Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching; active stretching; strengthening Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: NR | Suturing of large RC tear is not superior to debridement in the long term. |
| Mullett H, 2006 Country: UK Treatment category: Operative approach Questions: Q2, Q5 Funding: NR NOS: 6*/8* | Recruitment dates: Dec 2004 to Jun 2006 Study design: Prospective cohort Enrolled consecutively: no Followup duration, mean (range): 3 yr (12 mo–NR) Inclusion criteria: (1) sml & med RC tears Exclusion criteria: NR | Enrolled: 210 Analyzed: NR Withdrawals: NR Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 114 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: sm, med Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 96 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: sm, med Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: debridement Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: • VAS ROM: NR Strength: • strength (NR) Other: NR | The results of the study support arthroscopic RCR compared to decompression alone in patients with small and medium rotator cuff tears. |
| Nam SC, 2008 Country: South Korea Treatment category: Operative Questions: Q2, Q6 Funding: No funding BA Quality: Consecutive: U Followup: Y Outcome assessment: Y | Recruitment dates: Apr 2000 to Sep 2004 Study design: prospective cohort treated as before- and-after Enrolled consecutively: NR Followup duration, mean (range): 2.6 yr (16 mo–6.2 yr) Inclusion criteria: (1) arthroscopic RCR for RC tear with limited ROM; (2) AC group: crepitus heard during manipulation before RC repair Exclusion criteria: (1) partial/mass RC tears, (2) AC arthritis that required distal clavicular resection, (3) advanced glenohumeral arthritis, (4) WCB claim, (5) tenotomy or tenodesis of the long head of the biceps, (6) revision procedures | Enrolled: 45 Analyzed: 45 Withdrawals: 0 Duration since symptom onset, mean (range): Group 1: 11.7 mo (2 mo–5 yr) Group 2: 11.6 mo (1 mo–2.5 yr) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 15 Age, mean±SD (range): 59.8 yr (43–73 yr) Males %: 86.7 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: 66.7 (all) Comorbidities: shld stiffness(all); DM (5) GROUP 2 N: 30 Age, mean±SD (range): 56.1 yr (40–65 yr) Males %: 60 Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: see group 1 Comorbidities: DM (1) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); manipulation (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (1–6 mo); active-assisted stretching (wk 6); strengthening (wk ≥6) Rehab regime: Frequency– daily; Intensity–3×10 rounds/day GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: Frequency–daily; Intensity–3×10 rounds/day PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: • SST Function: • CMS • UCLA Pain: • VAS (active motion) • VAS (at rest) ROM: • abduction • forward flexion • external rotation • internal rotation (pos.) • cross-body adduction Strength: • forward flexion (kg) • external rotation (kg) • internal rotation (kg) Other: NR | Pts with FTT and stiffness of the shld can be tx with arthroscopic RCR and concomitant manipulation with results comparable to patients with no stiffness. |
| Nho SJ, 2009 Country: USA Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: Y Followup: N Outcome assessment: U | Recruitment dates: 2003 to 2005 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 2.4 yr Inclusion criteria: (1) imaging consistent with RC tear, (2) failure of nonoperative tx, (3) corticosteroid injection Exclusion criteria: (1) RCR not performed, (2) revision RCR, (3) glenohumeral OA | Enrolled: 193 Analyzed: 127 Withdrawals: 66 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: SS, IS, SC, TM (single, double, triple) GROUP 1 N: 193 Age, mean±SD (range): 58.6 yr Males %: 39.9 Cause of tear: NR Tear size: all sizes Dominant shoulder %: NR Comorbidities: SLAP lesion (36); biceps pathology (37) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); SLAP repair (1); biceps tenotomy/tenodesis (12)/(6); AC joint coplaning (28); distal clavicle excision (15) Duration of immobilization: NR Duration of rehab: NR Rehab components: Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS, cortisone injection | HRQL: NR Function: • ASES Pain: NR ROM: • flexion • external rotation Strength: • manual muscle testing • flexion • external rotation Other: • cuff integrity | Prognostic factors after arthroscopic RCR including age, tear size, and concomitant pathology influences outcomes. The progression from a single-tendon to multiple tendon tear with associated pathology increased the likelihood of tendon defect by at least 9 times. Earlier surgery provides better outcomes. |
| Ogilvie-Harris DJ, 1993 Country: Canada Treatment category: Operative approach Questions: Q2 Funding: No funding ROB: High | Recruitment dates: NR Study design (trial type): CCT (parallel) Enrolled consecutively: yes Followup duration, mean (range): NR (2–5 yr) Inclusion criteria: (1) pre-op dx based on history, (2) physical exam and failed nonoperative tx, (3) confirmation of dx and appropriate tear size Exclusion criteria: NR | Enrolled: 50 Analyzed: 45 Withdrawals: 5 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 25 Age, mean±SD (range): 30–39 (2); 40–49 (9); 50–59 (9); 60–69 (1); >69 (2) Males %: NR Cause of tear: NR Tear size: med, lg Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 25 Age, mean±SD (range): 30–39 (3); 40–49 (8); 50–59 (6); 60–69 (4); >69 (1) Males %: NR Cause of tear: NR Tear size: med, lg Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (wk 1–3); active-assisted stretching (wk 3–6); strengthening (6 wk–6 mo) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: active stretching (day 1–3 mo); strengthening (wk 6–3 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: NR | HRQL: NR Function: • UCLA Pain: NR ROM: NR Strength: NR Other: NR | Subacromial decompression and debridement is ideal for pts with limited demands and whose main complaints are pain and ROM loss. For patients who need good function and strength arthroscopic RCR is not suffficient, in which case the authors advise open repair. |
| Oh JH, 2008 Country: South Korea Treatment category: Operative Questions: Q2, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: Jan 2004 to Dec 2005 Study design: prospective cohort treated as before-and-after Enrolled consecutively: yes Followup duration, mean (range): 15.1 mo. (12 mo–2.7 yr) Inclusion criteria: symptomatic FTT with/without shld stiffness Exclusion criteria: (1) previous shld surgery, (2) revision repair, (3) irreparable tear, (4) existence of instability or cuff tear arthropathy | Enrolled: 125 (shld: 127) Analyzed: 125 (shld: 127) Withdrawals: 0 Duration since symptom onset, mean±SD (range): Group 1: 28.5±52.2 (NR) Group 2: 41.2±52 (NR) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: shld: 30 Age, mean±SD (range): 60.9±8.7 yr (NR) Males %: 50 Cause of tear: NR Tear size: all sizes Dominant shoulder %: NR Comorbidities: SLAP lesion (15); biceps pathology (12); AC arthritis (1); DM (3) GROUP 2 N: shld: 97 Age, mean±SD (range): 58.8±9.3 yr (NR) Males %: 45.4 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: SLAP lesion (45); biceps pathology (44); AC arthritis (10); DM (10) | GROUP 1 Surgical approach: open (21); all-arthroscopic (9) Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (12); manipulation (all); capsular release (all); clavicle resection (1) Duration of immobilization: sm tears: 4 wk; med tears: 5 wk; lg and mass tears: 6–7 wk Duration of rehab: NR Rehab components: sm/med: passive stretching (immediate); lg/mass: passive stretching (wk 2–4); active stretching once brace weaned; strengthening (wk 9–12) Rehab regime: NR GROUP 2 Surgical approach: open (62); all-arthroscopic (35) Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (44); distal clavicle resection (10) Duration of immobilization: sm: 4 wk; med: 5 wk; lg and mass: 6–7 wk Duration of rehab: NR Rehab components: sm/med: passive stretching (immediate); lg/mass: passive stretching (wk 2–4); active stretching once brace weaned; strengthening (wk 9–12) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES • CMS • SST Pain: • VAS ROM: • forward elevation • external rotation • internal rotation Strength: NR Other: • cuff integrity | Moderate pre-operative shoulder stiffness does not affect clinical outcomes of RC repair if arthroscopic capsular release is added to the index procedure. |
| Pai VS, 2001 Country: New Zealand Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: 1994 to 1997 Study design: Before-and-after Enrolled consecutively: yes Followup duration, mean (range): 34 mo (NR) Inclusion criteria: FTT Exclusion criteria: inadequate followup | Enrolled: 60 Analyzed: 54 (shld: 58) Withdrawals: 6 Duration since symptom onset, mean (range): Group 1: 9 mo (3–24 mo) Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+SC, SS+IS+SC GROUP 1 N: 60 Age, mean±SD (range): 65 yr (32–82 yr) Males %: 56.7 Cause of tear: degenerative (11), traumatic (47) Tear size: all sizes Dominant shoulder %: 66.7 Comorbidities: dislocated shld (1); biceps tendon rupture (7); OA; sclerosis of greater tuberosity; cystic changes; squaring; decreased AC space | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenodesis (3); distal clavical excision (11); repair of coracoacromial ligament (6) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (day 1–wk 6); active stretching (≥wk 6); strengthening when active motion was comfortable Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: exercise, physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: NR Pain: • pain at rest ROM: NR Strength: NR Other: NR | Acromioplasty and RCR can improve pain and shld function in patients with FTT. |
| Park JY, 2008 Country: South Korea Treatment category: Operative technique Questions: Q2, Q5, Q6 Funding: No funding NOS: 7*/8* | Recruitment dates: May 2002 to May 2004 Study design: prospective cohort Enrolled consecutively: yes Followup duration, mean (range): 2.1 yr (22 mo–2.5 yr) Inclusion criteria: FTT Exclusion criteria: (1) incomplete repair, (2) RC tears after shld fracture or dislocation | Enrolled: 85 Analyzed: 78 Withdrawals: 7 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 42 Age, mean±SD (range): 54.4 yr (28–76 yr) Males %: 52.4 Cause of tear: NR Tear size: sm/med, lg/mass Dominant shoulder %: NR Comorbidities: NR GROUP2 N: 43 Age, mean±SD (range): 57 yr (39–78 yr) Males %: 46.5 Cause of tear: NR Tear size: sm/med, lg/mass Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Technique: double-row knot tying Duration of immobilization: 5–8 wk Duration of rehab: NR Rehab components: passive stretching; active stretching (wk 5); strengthening (wk 8–10) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Technique: single-row Duration of immobilization: 5–8 wk Duration of rehab: NR Rehab components: passive stretching; active stretching (wk 5); strengthening (wk 8–10) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES • CMS Pain: NR ROM: NR Strength: • Shoulder Strength Index Other: NR | The single-row method should be used to repair small to medium RC tears and the double-row method should be used for repairing large to massive RC tears. |
| Park JY, 2004 Country: South Korea Treatment category: Operative Questions: Q2, Q5 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: NR Study design: Prospective cohort treated as before-and-after Enrolled consecutively: yes Followup duration, mean (range): 2.8 yr (2–5.2 yr) Inclusion criteria: PTT (>50% tears), FTT Exclusion criteria: (1) tears of thickness <6mm, (2) open RCR of mass RC tear | Enrolled: 42 Analyzed: 42 Withdrawals: 0 Duration since symptom onset, mean (range): 2.5 yr (1 mo–20 yr) Type of tear: FTT (20); PTT (22) Tendon(s) torn: NR GROUP 1 N: 22 Age, mean±SD (range): all groups: 55 yr (NR) Males %: NR Cause of tear: degenerative (15), traumatic (7) Tear size: NR Dominant shoulder %: NR Comorbidities: LHB tears (3); OA of AC joint (2) GROUP 2 N: 20 Age, mean±SD (range): see group 1 Males %: NR Cause of tear: degenerative (10), traumatic (10) Tear size: all sizes Dominant shoulder %: NR Comorbidities: OA (1) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy (3) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (up to wk 6); active stretching (≥wk 6) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (up to wk 6); active stretching (≥wk 6) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES Pain: • VAS ROM: • flexion • external rotation • internal rotation Strength: NR Other: NR | Satisfactory postoperative pain relief and functional recovery were obtained in both PTT and FTT groups repaired by arthroscopic RC repair and subacromial decompression. To avoid procedural failure, careful pre-operative examination of AC joint is critical. |
| Pearsall AW, 2007 Country: USA Treatment category: Operative approach Questions: Q2, Q6 Funding: Government NOS: 8*/8* | Recruitment dates: 1999 to 2003 Study design: Prospective cohort Enrolled consecutively: NR Followup duration, mean (range): 4.2 yr (2.3–7 yr) Inclusion criteria: (1) tear size between 1–5 cm, (2) minimum followup 24 mo, (3) complete pre-and postoperative evaluation Exclusion criteria: (1) massive RCTs, (2) acute tear repaired within 3 mo of injury, (3) <24 mo of followup; radiographic evidence of glenohumeral joint arthritis, (4) WCB | Enrolled: 54 Analyzed: 52 Withdrawals: 2 Duration since symptom onset, mean (range): 5.7 (3–16) mo Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 25 Age, mean±SD (range): 58 yr (41–76 yr) Males %: 40 Cause of tear: NR Tear size: med, lg Dominant shoulder %: NR Comorbidities: fraying of biceps tendon (12); humeral OA (4); glenoid OA (3); diabetes (5) GROUP 2 N: 27 Age, mean±SD (range): 55 yr (38–78 yr) Males %: 41 Cause of tear: NR Tear size: med, lg Dominant shoulder %: NR Comorbidities: fraying of biceps tendon (17); humeral OA (4); glenoid OA (2); diabetes (6) | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (23); distal clavicle excision (14); biceps tenotomy/tenodesis (NR); debridement of any exposed bone on humerus or glenoid (NR) Duration of immobilization: 6 wk Duration of rehab: 3 mo Rehab components: passive stretching (1–6 wk); active stretching & strengthening exercises (6 wk–3 mo) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (NR) distal clavicle excision (11); biceps tenotomy/tenodesis (NR); greater tuberosity abrasion (NR) Duration of immobilization: 6 wk Duration of rehab: 3 mo Rehab components: passive stretching (1–6 wk); active stretching & strengthening exercises (6 wk–3 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: PT NOS for 6 wk, cortisone injection (≥1 injection) | HRQL: NR Function: • UCLA Pain: • VAS ROM: • active flexion • active abduction • internal rotation at 90o • glenohumeral elevation • external rotation at 0o • external rotation at 90o Strength: NR Other: • Short Shoulder Test Improvement | No difference in outcomes between mini-open and arthroscopic repair and either procedure can be used in the treatment of small and medium-sized rotator cuff tears. |
| Pillay R, 1994 Country: Singapore Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: U Followup: U Outcome assessment: N | Recruitment dates: Dec 1988 to July 1991 Study design: retrospective cohort treated as before-and-after Enrolled consecutively: NR Followup duration (mean/range): group 1: 18 mo (6 mo–2.5 yr); group 2: 20 mo (6 mo–2.5 yr) Inclusion criteria: (1) chronic impingement syndrome, (2) arthroscopic subacromial decompression Exclusion criteria: NR | Enrolled: 40 (shld: 42) Analyzed: 34 (shld: 36) Withdrawals: NR Duration since symptom onset, mean (range): Group 1: 18 mo (NR); Group 2: 12.5 mo (NR) Type of tear: FTT (8); PTT (20) Tendon(s) torn: NR GROUP 1 N: 26 Age, mean±SD (range): 50.2 yr (33–75 yr) Males %: 50 Cause of tear: NR Tear size: NR Dominant shoulder %: 77 Comorbidities: All groups: diabetic neuropathy and cervical radiculopathy (1 total) GROUP 2 N: 8 (shld: 10) Age, mean±SD (range): 52 yr (51–71 yr) Males %: 62.5 Cause of tear: NR Tear size: all sizes Dominant shoulder %: 100 Comorbidities: see goup 1 | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: active-assisted and active stretching (≥day 1) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: active-assisted and active stretching (≥day 1) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: NR | HRQL: NR Function: • UCLA Pain: NR ROM: NR Strength: NR Other: • number of pts with improvemed UCLA | Arthroscopic subacromial decompression is effective for tx of PTT and impingement syndrome. |
| Porcellini G, 2006 Country: Italy Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: Jan 2000 to May 2002 Study design: retrospective cohort treated as before-and-after Enrolled consecutively: yes Followup duration, mean (range): 3 yr (2–4.3 yr) Inclusion criteria: All: (1) 40–60 yr, (2) no disclocation of unaffected shld, (3) negative apprehension and relocation signs in the unaffected shld, (4) sulcus sign negative bilaterally, (5) no fracture of the glenoid/tuberosities Group 1/3: (1) ≥1 episodes of instability, (2) instability (3) no engaging Hill-Sacks lesion, (4) lesion of the glenoid labrum or capsule Group 2/3: (1) postive cuff signs on pre-operative examination, (2) cuff signs, (3) complete RC tear with ≥1 tendon Group 1: negative RC signs, (2) no sign of RC tear, (3) intact RC cuff or fraying of the articular side of cuff Group 2: (1) no shld instability, (2) negative apprehension and relocation signs in affected shoulder, (3) no instability, (4) no lesion of the glenoid labrum or capsule Exclusion criteria: (1) open surgery, (2) lesions different from those in inclusion, (3) acromion-humeral distance <5 mm, (4) axillary or SC palsy, (5) SC tendon lesion associate with lesion of the ant. And pos. glenoid labrum, (6) pts with PTT associated with a SLAP lesion | Enrolled: 100 Analyzed: 100 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT (100); PTT (6 – in group 1) Tendon(s) torn: SS, IS, SC, SS+IS, SS+IS+SC, SS+SC, IS+TM GROUP 1 N: 50 Age, mean±SD (range): 47.5±6.36 yr (NR) Males %: 64 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 50 Age, mean±SD (range): 48.1±6.4 yr (NR) Males %: 82 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: Bankart lesions (12); capsular lesions (18); labrum capsule (20); recument ant. Dislocation of shld associated with a cuff tear (all) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): NR Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching (wk 3–8); passive and active stretching (wk 5); strengthening (≥wk 8); Modalities–pool Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): labral repair (NR) Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching (wk 3–8); passive and active stretching (wk 5); strengthening (≥wk 8); Modalities–pool Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • Rowe score Pain: NR ROM: NR Strength: NR Other: NR | RC tears and glenohumeral instability are closely related and may affect outcome. Authors recommend arthroscopic RCR. |
| Prasad N, 2005 Country: UK Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: 2000 to 2003 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 1.2 yr (12 mo–4.2 yr) Inclusion criteria: NR Exclusion criteria: NR | Enrolled: 42 Analyzed: 40 Withdrawals: 2 Duration since symptom onset, mean (range): 4.7 yr (6 mo–15 yr) Type of tear: FTT Tendon(s) torn: SS, SS+IS, SC, SS+IS+SC GROUP 1 N: 42 Age, mean±SD (range): 63 yr (22–82 yr) Males %: 71.4 Cause of tear: degenerative (26), traumatic (16) Tear size: all sizes Dominant shoulder %: 90.5 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS Pain: • VAS ROM: NR Strength: NR Other: NR | Older pts and those with mass RC tear could benefit from surgery, although not as much as younger pts and those with small/moderate size cuff tears. |
| Raab MG, 1996 Country: USA Treatment category: Post operative rehabilitation Questions: Q2, Q5, Q6 Funding: NR ROB: High | Recruitment dates: Dec 1992 to Jan 1994 Study design (trial type): RCT (parallel) Enrolled consecutively: yes Followup duration (endpoint): 3 mo Inclusion criteria: NR Exclusion criteria: NR | Enrolled: 41 Analyzed: 26 Withdrawals: 15 Duration since symptom onset, mean (range): NR Type of tear: FTT (24); PTT (2) Tendon(s) torn: NR GROUP 1 N: 14 Age, mean±SD (range): 58 yr (NR) Males %: 64.3 Cause of tear: NR Tear size: sm/med, lg/mass Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 12 Age, mean±SD (range): 58 yr (NR) Males %:75 Cause of tear: NR Tear size: sm/med, lg/mass Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: NR Type of surgery: repair Additional procedures (N): acromioplasty (14) Duration of immobilization: NR Duration of rehab: ≥6 wk Rehab components: passive stretching (wk 1–3); active-assisted stretching (≥wk 4–6); physical therapy NOS (≥wk 6) Rehab regime: Frequency–daily for 3 wk; Intensity–8 hr/day GROUP 2 Surgical approach: NR Type of surgery: repair Additional procedures (N): acromioplasty (12) Duration of immobilization: NR Duration of rehab: ≥6 wk Rehab components: passive stretching (wk 1–3); active-assisted stretching and physical therapy NOS (wk 4–6) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • Shoulder Score Pain: NR ROM: NR Strength: NR Other: NR | CPM had no effect on overall shld score with 3 mo followup. CPM had a beneficial effect on ROM for all pt, and pain relief in female pts and pts ≥60 yr. |
| Randelli PS, 2008 Country: UK Treatment category: Operative Questions: Q2, Q5 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: U | Recruitment dates: Jan to May 2004 Study design: before-and-after Enrolled consecutively: NR Followup duration (endpoint): 24 mo Inclusion criteria: (1) FTT (2) underwent arthroscopic RCR, (3) wore a brace for 4 wk post operatively, (4) gave informed consent, (5) pre-operative platelet count >150,000, (6) min pre-operative hemoglobin of 11.0g/dl, (7) no infectious diease or any disease to limit followup, (8) unilateral RC tear Exclusion criteria: (1) tear involving SC or biceps tendons, (2) previous RCR, (3) moderate to severe glenohumeral OA, (4) >20° loss of passive flexion compared to contralateral shld, (5) fatty infiltration >50% of SS or IS, (6) mass tear in a contracted immobile cuff, (7) infection, (8) metabolite bone disorders, (9) un-cooperative/difficulty with directions, (10) vascular insufficiency, muscular atrophy, or neuromuscular diseases of the affected arm | Enrolled: 14 Analyzed: 13 Withdrawals: 1 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 14 Age, mean±SD (range): 66.6±9 yr (NR) Males %: 57.1 Cause of tear: NR Tear size: NR Dominant shoulder %: 71.4 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: 10 days; followed by 18 nights of immobilization Duration of rehab: NR Rehab components: passive stretching (day 10); active stretching (≥1 mo) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: bull; CMS • UCLA Pain: • VAS ROM: NR Strength: NR Other: NR | Preliminary results indicate that the application of platelet rich plasma during RCR is safe and effective. |
| Roddey TS, 2002 Country: USA Treatment category: Post-op rehabilitation Questions: Q2 Funding: Foundation ROB: High | Recruitment dates: NR Study design (trial type): RCT (NR) Enrolled consecutively: NR Followup duration (endpoint): 52 wk Inclusion criteria: (1) FTT, (2) arthroscopic RCR Exclusion criteria: (1) RA, (2) previous surgery on involved shld | Enrolled: 129 Analyzed: 108 Withdrawals: 21 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 54 Age, mean±SD (range): 58.7±10.6 yr (34.6–78.0 yr) Males %: 66.7 Cause of tear: NR Tear size: mean: 2.5 cm, range: 1–5 cm, mass tears n=4 Dominant shoulder %: NR Comorbidities: For all groups: biceps tear (5); SLAP lesion (5); Bankart lesion (1) GROUP 2 N: 54 Age, mean±SD (range): 57.2±9.1 yr (40.0–75.8 yr) Males %: 61.1 Cause of tear: NR Tear size: mean: 2.6 cm; range:1.5–4.0 cm, mass tears n=8 Dominant shoulder %: NR Comorbidities: see group1 | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): all groups: acromioplasty (all); manipulation (3); SLAP repair (5); biceps tear repair (1); Bankart repair (1) Duration of immobilization: 6 wk Duration of rehab: 52 wk Rehab components: passive stretching (day 1–6 wk); active stretching (wk 6 onward); strengthening (≥3 mo); free-weight exercise and weight bearing exercise (6 mo onward) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): see group1 Duration of immobilization: 6 wk Duration of rehab: 52 wk. Rehab components: passive stretching (day 1); active stretching (≥wk 6); strengthening (3 mo); free-weight exercise and weight bearing exercise (6 mo onward) Rehab regime: Frequency–NR; Intensity–15 min./phase PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • PENN • SPADI Pain: NR ROM: NR Strength: NR Other: NR | With a therapist available for questions, patients who used the videotape method for their home program instruction had self-reported outcomes equal to patients instructed in their home program personally by a physical therapist. Self-reported compliance with the rehabilitation program had little effect on the outcomes. |
| Rokito AS, 1999 Country: USA Treatment category: Operative Questions: Q2, Q5 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: Jun 1989 to Jul 1993 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 65 mo (46–93 mo) Inclusion criteria: lg or mass, reparable chronic tear of RC Exclusion criteria: (1) irreparable tears, (2) previous procedure involving the shld, (3) symptoms in the contralateral shld | Enrolled: 30 Analyzed: 30 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 30 Age, mean±SD (range): 57 yr (39–78 yr) Males %: 70 Cause of tear: NR Tear size: lg, mass Dominant shoulder %: 76.7 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (≥day 1); active stretching (≥wk 6–8); strengthening (≥wk12) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: exercise, NSAID | HRQL: NR Function: • UCLA Pain: NR ROM: NR Strength: • isokinetic strength (flexion, abduction, external rotation) Other: NR | Large or massive RC tears can have satisfactory outcomes with operative RCR but more than one year is needed for restoration of strength. |
| Sauerbrey AM, 2005 Country: USA Treatment category: Operative approach Questions: Q2, Q6 Funding: NR NOS: 6*/8* | Recruitment dates: Jan 1997 to Dec 1999 Study design: retrospective cohort Enrolled consecutively: yes Followup duration, mean (range): Group 1: 33 mo (18–48 mo); Group 2: 19 mo (13–26 mo) Inclusion criteria: (1) FTT, (2) followup ≥1 yr Exclusion criteria: NR | Enrolled: 63 Analyzed: 54 Withdrawals: 9 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 26 Age, mean±SD (range): 57 yr (40–84 yr) Males %: 61.5 Cause of tear: degenerative (6), traumatic (16), NR (4) Tear size: med, lg, mass Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 28 Age, mean±SD (range): 56 yr (38–86 yr) Males %: 57.1 Cause of tear: degenerative (7), traumatic (15), NR (6) Tear size: med, lg, mass Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (all); labral repair (2); biceps tenotomy (3)/tenodesis (4); distal clavicle excision (5); capsular release (2) Duration of immobilization: 4–6 wk Duration of rehab: NR Rehab components: passive stretching (day 1–wk 6); active stretching (wk 6–≥1 yr); strengthening (wk 6–≥1 yr) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenodesis (7); distal clavicle excision (5); capsular release (3); Duration of immobilization: 4–6 wk Duration of rehab: NR Rehab components: passive stretching (day 1–wk 6); active stretching (wk 6–≥1 yr); strengthening (≥wk 6–≥1 yr) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: • ASES Pain: NR ROM: NR Strength: NR Other: NR | Short-term results for arthroscopic and mini-open RCR are similar. This study supports the continued use of arthroscopic RCR techniques. |
| Scheibel M, 2007 Country: Germany Treatment category: Operative Questions: Q2, Q5 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: U | Recruitment dates: May 2003 to May 2004 Study design: before- and-after Enrolled consecutively: NR Followup duration, mean (range): 14.4 mo (12–21 mo) Inclusion criteria: degenerative symptomatic FTT SS tears with variable ant./pos. expansion into the upper SC or IS Exclusion criteria: (1) PTT; (2) traumatic history; (3) previous surgery on the affected shld; (4) signs of cuff tear arthropathy; (5) grade III tendon retraction according to Patte, grade III atrophy according to Thomazeau + grade III- IV fatty infiltration according to Goutailler adjusted to MRI scans by Fuchs; (6) intraoperatively dx tears having to be fixed using side to side technique | Enrolled: 23 Analyzed: 20 Withdrawals: 3 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS, SS+IS, SS+SC, SS+IS+SC GROUP 1 N: 23 Age, mean±SD (range): 59.7 yr (44–71 yr) Males %: 69.6 Cause of tear: NR Tear size: med, lg, mass Dominant shoulder %: 73.9 Comorbidities: ectopic ossification in SS tendon (4); biceps pathology (19); controlled hypertension (5); DM type II (1); chronic bronchitis (1) | GROUP 1 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenodesis (18); AC joint resection (9) Duration of immobilization: 4 wk Duration of rehab: NR Rehab components: passive stretching (wk 1–6); active-assisted and active stretching (≥wk 6) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • SST Pain: NR ROM: NR Strength: NR Other: • cuff integrity | Open RCR augmented with an autologous periosteal flap shows high patient satisfaction level with low re-rupture rates. |
| Scheibel M, 2004 Country: Germany Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: U | Recruitment dates: Apr 1997 to Sept 2000 Study design: before- and-after Enrolled consecutively: NR Followup duration, mean (range): 3.3 yr (20 mo–4.8 yr) Inclusion criteria: (1) mass defect of RC, (2) 3 mo conservative therapy Exclusion criteria: previous surgery on the shld | Enrolled: 23 Analyzed: 22 Withdrawals: 1 Duration since symptom onset, mean (range): 12 mo (3–48 mo) Type of tear: FTT Tendon(s) torn: SS+IS, SS+IS+SC, SS+SC GROUP 1 N: 23 Age, mean±SD (range): 69 yr (60–81 yr) Males %: 78.3 Cause of tear: degenerative (14), traumatic (8) Tear size: mass Dominant shoulder %: 65.2 Comorbidities: biceps pathology (16); OA (3) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: debridement Additional procedures (N): acromioplasty (all); biceps tenotomy/tenodesis (NR); tuberoplasty (NR) Duration of immobilization: 24 hr Duration of rehab: 3 mo Rehab components: passive stretching (immediately–wk 2); active stretching (wk 2–3 mo); strengthening (wk 2–3 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: NR | Reversed arthorscopic subacromial decompression with tenotomy of the LHB tendon offers a less invasive tx strategy for massive RC tears while preserving the integrity of the corcoacromial arch. |
| Scheuermann R, 1991 Country: Germany Treatment category: Nonoperative Questions: Q3 Funding: Industry Other: German BA Quality: Consecutive: U Followup: Y Outcome assessment: U | Recruitment dates: NR Study design: Before- and-after Enrolled consecutively: NR Followup duration (endpoint): 25 days Inclusion criteria: RC rupture Exclusion criteria: (1) complete loss of function and resistant to conservative therapy, (2) long-term ruptures | Enrolled: 29 Analyzed: 24 Withdrawals: 5 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 29 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Intervention: active ROM, strengthening, soft tissue massage, posture control, active shld support with bandage Drug name: NR Duration of treatment: 25 days Treatment Regime: NR Degree of supervision: direct one- to-one Treatment provider: PT | HRQL: NR Function: NR Pain: NR ROM: • abduction • flexion • external rotation • abduction • extension • nternal rotation Strength: NR Other: • number of pts with pain at endpoint • number of pts needing operation | Early functional physical therapy and active shoulder support resulted in pain relief and earlier usability of shoulder joint. |
| Severud EL, 2003 Country: USA Treatment category: Operative approach Questions: Q2, Q5, Q6 Funding: NR NOS: 4*/8* | Recruitment dates: Sep 1992 to Aug 1998 Study design: retrospective cohort Enrolled consecutively: yes Followup duration, mean (range): 3.7 yr (2–6.8 yr) Inclusion criteria: (1) FTT, (2) WCB cases Exclusion criteria: (1) other significant intra-articular pathology, (2) previous RC surgery, (3) mass RC tears, ( 4) neurological disorders | Enrolled: 75 (shld: 82) Analyzed: 58 (shld: 64) Withdrawals: 17 (shld: 18) Duration since symptom onset, mean (range): Group 1: 10.8 mo (NR); Group 2: 15.7 mo (NR) Type of tear: FTT (54); PTT (4) Tendon(s) torn: NR GROUP 1 N: NR (shld: 29) Age, mean±SD (range): 63.3 yr (NR) Males %: 62.1 of shld Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: All groups: ruptured LHB (2); biceps tendon fraying (5) GROUP 2 N: NR (shld: 35) Age, mean±SD (range): 58.7 yr (NR) Males %: 60 of shld Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: see group 1 | GROUP 1 Surgical approach: mini-open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (up to wk 4); active-assisted stretching (≥wk 4); strengthening (3 mo) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (up to wk 4); active-assisted stretching (≥wk 4); strengthening (3 mo) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: NR Function: • ASES • UCLA Pain: NR ROM: NR Strength: NR Other: NR | All-arthroscopic RCR provides comparable outcomes and complication rates to arthroscopic decompression with mini-open RCR. The lower incidence of fibrous ankylosis favors the all-arthroscopic technique. Better early motion was obtained in the all- arthroscopic group. |
| Shibata Y, 2001 Country: Japan Treatment category: Nonoperative Questions: Q3, Q5, Q6 Funding: NR ROB: High | Recruitment dates: NR Study design (trial type): RCT (parallel) Enrolled consecutively: NR Followup duration (endpoint): 24 wk Inclusion criteria: 1) FTT Exclusion criteria: 1) intra-articular injection of drugs; 2) abnormal hepatic/renal function; 3) pregnant; 4) severe osteoarthritic changes of affected shld; 5) symptoms resulting from surgical lesions | Enrolled: 78 Analyzed: 78 Withdrawals: 0 Duration since symptom onset, mean±SD (range): Group 1: 5.8±5.4 mo (NR) Group 2: 4.7±5.7 mo (NR) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 38 Age, mean±SD (range): 59.5±9.1 yr (NR) Males %: 71.1 Cause of tear: degenerative (19), traumatic (19) Tear size: NR Dominant shoulder %: 60.5 Comorbidities: NR GROUP 2 N: 40 Age, mean±SD (range): 62.4±8.6 yr (NR) Males %: 70 Cause of tear: degenerative (17), traumatic (23) Tear size: NR Dominant shoulder %: 67.5 Comorbidities: NR | GROUP 1 Intervention (modality): strengthening, sodium hyaluronate injection (25 mg + 3ml of 1% lidocaine), heat Drug name: loxoprofen (180mg/d) Duration of treatment: 5 wk Treatment Regime: Frequency–1/wk; Intensity–NR Degree of supervision: NR Treatment provider: NR Additional comments: If pts were unsatisfied with tx >4 wk., they were offered surgery. Pts who chose nonoperative tx were prescribed NSAIDS and physical therapy; examined 24 wk after last intra-articular injection. If shld disability resolved, injections were discontinued GROUP 2 Intervention (modality): strengthening, corticosteroid injection (2mg dexamethasone + 3ml of 1% lidocaine), heat/cold Drug name: loxoprofen (180mg/d) Duration of treatment: 5 wk, Treatment Regime: Frequency–1/wk; Intensity–NR Degree of supervision: NR Treatment provider: NR Additional comments: see group 1 | HRQL: NR Function: • UCLA Pain: NR ROM: • abduction • external rotation • internal rotation Strength: NR Other: NR | Therapeutic efficacy in the sodium hyaluronate group was equivalent to that in the steroid group. |
| Sugaya H, 2007 Country: Japan Treatment category: Operative Questions: Q2, Q5 Funding: No funding BA Quality: Consecutive: Y Followup: U Outcome assessment: U | Recruitment dates: Apr 2001 to May 2003 Study design: before- and-after Enrolled consecutively: yes Followup duration, mean (range): 2.6 yr (2–4.1 yr) Inclusion criteria: (1) FTT, (2) arthroscopic double- row repair, (3) MRI of RC between 1–2 yr post operative, (4) final functional eval ≥2 yr postoperative Exclusion criteria: (1) PTT, (2) nonarthroscopic RCR because of mass irreparable tears with fatty degeneration and atrophy | Enrolled: 106 Analyzed: 86 Withdrawals: 20 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 106 Age, mean±SD (range): 60.5 yr (41–77 yr) Males %: 49.1 Cause of tear: NR Tear size: all sizes Dominant shoulder %: 59.4 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: 3–4 wk Duration of rehab: NR Rehab components: isometric exercises (day 1); active and passive stretching (after immobilization period ended); strengthening (wk 6) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES • JOA • UCLA Pain: NR ROM: NR Strength: NR Other: • cuff integrity | Arthroscopic RCR has demonstrated improved repair integrity compared with tradditional open or mini-open RCR. Retear rate with large and massive tears was still higher than that for small tears. |
| Sugaya H, 2005 Country: Japan Treatment category: Operative technique Questions: Q2, Q5 Funding: NR NOS: 6*/8* | Recruitment dates: Feb 1999 to Apr 2002 Study design: retrospective cohort Enrolled consecutively: yes Followup duration, mean (range): 2.9 yr (2–5 yr) Inclusion criteria: (1) failed nonoperative tx, (2) FTT, (3) no major associated pathology (glenoid fracture or Bankart lesion) Exclusion criteria: PTT | Enrolled: 104 (Shld: 106) Analyzed: 80 (shld: 80) Withdrawals: 26 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: NR (shld: 55) Age, mean±SD (range): 58.1 yr (36–73 yr) Males %: 50.9 of shld Cause of tear: NR Tear size: all sizes Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: NR (shld: 51) Age, mean±SD (range): 57.7 yr (34–72 yr) Males %: 54.9 of shld Cause of tear: NR Tear size: all sizes Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all) Technique: double-row mattress fashion sliding knot; side to side stitches if longitudinal/U-shaped tears Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: isometric cuff exercise and relaxation of muscle (day 1–wk 3); active and active-assisted stretching (wk 3–6); strengthening (≥wk 6) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all) Technique: single-row metal suture self locking Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: isometric cuff exercise and relaxation of muscle (day 1–wk 3); active and active assisted stretching (wk 3–6); strengthening (≥wk 6) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES • UCLA Pain: NR ROM: NR Strength: NR Other: • cuff integrity | Successful functional outcomes obtained by arthroscopic RCR, without significant difference between single and dual-row fixation technique. However, in structural outcomes dual-row excelled over single-row technique. |
| Tashjian RZ, 2006 Country: USA Treatment category: Operative Questions: Q2, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: N Outcome assessment: N | Recruitment dates: NR Study design: before- and-after Enrolled consecutively: yes Followup duration, (endpoint): 1 yr Inclusion criteria: (1) chronic FTT (symptoms ≥ 3 mo), (2) failure of nonoperative tx Exclusion criteria: glenohumeral arthritis, AC | Enrolled: 125 (shld: 125) Analyzed: 125 (shld: 125) Withdrawals: 0 Duration since symptom onset, mean±SD (range): 16±25.9 mo (3 mo–18 yr) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 125 (shld: 125) Age, mean±SD (range): 56 yr (32–80 yr) Males %: 57.6 Cause of tear: degenerative (46), traumatic (79) Tear size: mean: 2.2 cm, range:1–4cm Dominant shoulder %: NR Comorbidities: number of comorbidities: 1.9±1.5/0–6 (mean/range) | GROUP 1 Surgical approach: open (26); mini-open (62); all-arthorscopic (37) Type of surgery: repair Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: physical therapy NOS, cortisone injection | HRQL: • SF-36 • VAS-QOL Function: • DASH • SST • VAS function Pain: • VAS pain ROM: NR Strength: NR Other: NR | Pts with more medical comorbidities have a worse general health status after RC repair; although they have greater improvement in overall shld pain, function and quality of life scores compared with pre-operative scores. |
| Tauro JC, 2006 Country: USA Treatment category: Operative Questions: Q2, Q5, Q6 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: NR Study design: Retrospective cohort treated as before-and- after Enrolled consecutively: yes Followup duration, mean (range): 2 yr (NR) Inclusion criteria: (1) FTT, (2) arthroscopic RCR Exclusion criteria: NR | Enrolled: 74 Analyzed: 72 Withdrawals: 2 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: Group 1 and 2: SS, IS, SC; Group 3: SS, IS GROUP 1 N: 42 Age, mean±SD (range): 70 yr (NR) Males %: NR Cause of tear: NR Tear size: mean: 3.7 cm Dominant shoulder %: NR Comorbidities: (all groups): hypertension; heart disease; DM GROUP 2 N: 24 Age, mean±SD (range): 70 yr (NR) Males %: NR Cause of tear: NR Tear size: mean: 7.7 cm Dominant shoulder %: NR Comorbidities: see group 1 GROUP 3 N: 6 Age, mean±SD (range): 70 yr (NR) Males %: NR Cause of tear: NR Tear size: mean: 12.3 cm Dominant shoulder %: NR Comorbidities: see group 1 | ALL GROUPS Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures: NR Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching and strengthening (up to wk 5/6); active stretching (≥wk 5/6) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 4.4 mo (2–8 mo) Type of treatment: physical therapy NOS, cortisone injection | HRQL: NR Function: • UCLA Pain: NR ROM: NR Strength: NR Other: • total ROM deficit | Pts who undergo RCR commonly have pre-operative stiffness. Routine therapy after surgery can resolve mild to moderate stiffness. Pts with total ROM deficit ≥70° may have adhesive capsulitis as well as a cuff tear and may not do well with RCR alone. |
| Tauro JC, 2004 Country: USA Treatment category: Operative Questions: Q2, Q5, Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: N | Recruitment dates: NR Study design: before- and-after Enrolled consecutively: yes Followup duration, mean (range): 2.7 yr (2–4 yr) Inclusion criteria: lg contracted tears, not adequately mobilized without a rotator interval release Exclusion criteria: significant SC tears requiring open RCR | Enrolled: 42 (shld: 43) Analyzed: 41 (shld: 42) Withdrawals: 1 Duration since symptom onset, mean (range): 12.4 mo (2–5 yr) Type of tear: NR Tendon(s) torn: SS, SS+IS GROUP 1 N: 42 (shld: 43) Age, mean±SD (range): 70 yr (46–86 yr) Males %: NR Cause of tear: degenerative (24), traumatic (18) Tear size: mean (range): ant. To pos.: 3.4 cm (2.5–5 cm), medial to lateral: 3.1 cm (2.5–3.5 cm) Dominant shoulder %: 66.7 Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); capsular release (all) Duration of immobilization: 1 day Duration of rehab: NR Rehab components: passive stretching and strengthening (day 3–4); active stretching (wk 5–6); active strengthening (wk 8–10) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • modified UCLA Pain: NR ROM: NR Strength: NR Other: NR | Interval slide technique improves SS mobility in large retracted tears. |
| Torrens C, 2003 Country: Spain Treatment category: Operative approach Questions: Q2, Q5 Funding: NR ROB: High | Recruitment dates: NR Study design (trial type): CCT (NR) Enrolled consecutively: yes Followup duration, mean (range): 18 mo (NR) Inclusion criteria: (1) impingement symptoms, (2) failure of ≥3 mo conservative tx Exclusion criteria: NR | Enrolled: 42 Analyzed: 42 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 20 Age, mean±SD (range): 55.9 yr (NR) Males %: 20 Cause of tear: NR Tear size: sm, med, lg, mass Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 22 Age, mean±SD (range): 63.8 yr (NR) Males %: 18.2 Cause of tear: NR Tear size: sm, med, lg, mass Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 2 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: yes Duration: 3 mo (min) Type of treatment: NR | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: NR | Increasing the subacromial space, preserving the anatomy of subacromial arch, provides functional results in the modified acromioplasty that are as good as those obtained with classical open acromioplasty. |
| Trenerry K, 2005 Country: Australia Treatment category: Operative Questions: Q2, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: Jul 1996 to Mar 2001 Study design: case- control treated as before-and-after Enrolled consecutively: yes Followup duration, mean (range): 17.5 mo (15.6–19.3 mo) Inclusion criteria: (1) RCR, (2) pt with outcomes in the upper quartile of the total cohort for at least 3 out of 4 ROM measures and pts with outcomes in the lower quartile Exclusion criteria: (1) incomplete repair of RC tears, (2) previous RC repair of involved shld/additional procedure at the time of symptoms | Enrolled: 75 Analyzed: 75 Withdrawals: 0 Duration since symptom onset, mean (range): Group 1: 22 mo (13 mo–2.6 mo) Group 2: 13 mo (6–20 mo) Type of tear: FTT (67); PTT (8) Tendon(s) torn: NR GROUP 1 N: 39 Age, mean±SD (range): 60 yr (56–64 yr) Males %: 69.2 Cause of tear: degenerative (18), traumatic (21) Tear size: mean: 4 cm2, range: 2–6 cm2 Dominant shoulder %: 66.7 Comorbidities: glenohumeral OA; AC joint arthritis; synovitis; bursitis; LHB tear GROUP 2 N: 36 Age, mean±SD (range): 63 yr (60–66 yr) Males %: 52.8 Cause of tear: degenerative (15), traumatic (21) Tear size: mean: 5 cm2, range:3–7 cm2 Dominant shoulder %: 91.7 Comorbidities: glenohumeral OA; AC joint arthritis; synovitis; bursitis; LHB tear | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 2 days Duration of rehab: 3 mo Rehab components: home exercise regimen; Modalities–cold Rehab regime: NR GROUP 2 Surgical approach: open Type of surgery: repair Additional procedures (N): acromioplasty (all) Duration of immobilization: 2 days Duration of rehab: 3 mo Rehab components: home exercise regimen; Modalities–cold Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: NR Pain: • frequency of activity pain ROM: • flexion (passive) • external rotation (passive) • abduction (passive) • hand behind back (passive) Strength: • isometric muscle force for internal/external rotation, and flexion Other: NR | Restriction of ROM, pre- operative hand behind back predicted shoulder stiffness at 6 wk. postoperative, findings affirm the potential for almost complete recovery of ROM and reduction of pain in pts who have shld stiffness after RC repair. |
| Vad VB, 2002 Country: USA Treatment category: Non- operative vs. operative Questions: Q2, Q4, Q6 Funding: NR NOS: 5*/8* | Recruitment dates: 1990 to 1995 Study design: retrospective cohort Enrolled consecutively: NR Followup duration, mean (range): 3.2 yr (2–7 yr) Inclusion criteria: (1) chronic atraumatic, FTT of ≥2 tendons, (2) mass tear Exclusion criteria: history of surgery on shld | Enrolled: 108 Analyzed: 108 Withdrawals: 0 Duration since symptom onset, mean (range): 6.3 mo (1–17 mo) Type of tear: FTT Tendon(s) torn: NR GROUP 1 and 2 N: 40 Age, mean±SD (range): 63.2 yr (46–85 yr) Males %: 46 (all) Cause of tear: degenerative (40) Tear size: mass Dominant shoulder %: 75 Comorbidities: NR GROUP 3 N: 36 Age, mean±SD (range): 59.4 yr (46–85 yr) Males %: see group 1 Cause of tear: degenerative (36) Tear size: mass Dominant shoulder %: 86.1 Comorbidities: NR GROUP 4 N: 32 Age, mean±SD (range): 62.9 yr (46–85 yr) Males %: see group 1 Cause of tear: degenerative (32) Tear size: mass Dominant shoulder %: 68.8 Comorbidities: NR | GROUP 1 Intervention: PT NOS, NSAIDs Drug name: NR Duration of treatment: 8.2 wk (1–22 wk) Treatment Regime: Frequency–NR; Intensity– 1.6 (1–4) injections Degree of supervision: NR Treatment provider: PT GROUP 2 Intervention: PT NOS, NSAIDs, corticosteroid injection Drug name: NR Duration of treatment: 10.3 wk (2–24 wk) Treatment Regime: NR Degree of supervision: NR Treatment provider: PT GROUP 3 Surgical approach: NR Type of surgery: repair Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR GROUP 4 Surgical approach: all-arthroscopic Type of surgery: debridement Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: NR | HRQL: NR Function: • Insalata Pain: NR ROM: • abduction • time to maximal ROM Strength: NR Other: NR | Poor outcomes in the tx of RC tears correlates with the presence of ≥3 of the following: positive prognostic factors: glenohumeral arthritis, decreased passive ROM, superior migration of humeral head, presence of atrophy, or strength <3. |
| Vaz S, 2000 Country: France Treatment category: Operative Questions: Q2, Q6 Funding: NR BA Quality: Consecutive: U Followup: Y Outcome assessment: Y | Recruitment dates: Mar 1994 to 1996 Study design: before- and-after Enrolled consecutively: NR Followup duration, mean (range): 3.1 yr (12 mo–4 yr) Inclusion criteria: sub-acromial impingment alone or impingement wtih PTT/FTT Exclusion criteria: NR | Enrolled: 14 Analyzed: 14 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT (8); PTT (6) Tendon(s) torn: NR GROUP 1 N: 14 Age, mean±SD (range): NR Males %: NR Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: debridement Additional procedures (N): acromioplasty (all) Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 mo (min) Type of treatment: physical therapy NOS | HRQL: NR Function: • CMS Pain: NR ROM: NR Strength: NR Other: • return to work | The CMS was satisfactory in 86% of cases. |
| Verma NN, 2006 Country: USA Treatment category: Operative approach Questions: Q2, Q5 Funding: NR NOS: 6*/8* | Recruitment dates: Jan 2000 to May 2002 Study design: retrospective cohort Enrolled consecutively: yes Followup duration, mean (range): 3.2 yr (2–8.1 yr) Inclusion criteria: (1) arthroscopic/mini-open RCR, (2) followup >2 yr Exclusion criteria: (1) revision, (2) SC tear, (3) partial/irreparable tears, (4) open RCR | Enrolled: 127 Analyzed: 71 Withdrawals: 56 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 58 Age, mean±SD (range): 60.7±10.4 yr (NR) Males %: 39.7 Cause of tear: NR Tear size: sm/med, lg/mass Dominant shoulder %: 39.7 Comorbidities: NR GROUP 2 N: 69 Age, mean±SD (range): 59.5±8.6 yr (NR) Males %: 31.9 Cause of tear: NR Tear size: sm/med, lg/mass Dominant shoulder %: 33.3 Comorbidities: NR | GROUP 1 Surgical approach: mini-open Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy (1)/tenodesis (2); clavicle excision (4); SLAP repair (9) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (wk 6–12); active stretching and strengthening (≥wk 12) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair Additional procedures (N): acromioplasty (all); biceps tenotomy(3); clavicle excision (4); SLAP repair (6) Duration of immobilization: 6 wk Duration of rehab: NR Rehab components: passive stretching (wk 6–12); active stretching and strengthening (≥wk 12) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES • Insalata • SST Pain: • VAS ROM: • forward flexion • external rotation • internal rotation • abduction Strength: NR Other: • satisfaction • cuff integrity | No clinical differences were found in outcomes for mini-open RCR compared to arthroscopic RCR. |
| Vitale MA, 2007 Country: USA Treatment category: Operative Questions: Q2 Funding: Foundation BA Quality: Consecutive: U Followup: Y Outcome assessment: N | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: NR Followup duration, mean (range): 1 yr (NR) Inclusion criteria: (1) RC tear, (2) ≥12 mo of failed nonoperative tx, (3) 40–80 yr, (4) ability to communicate with investigators, (5) give informed consent Exclusion criteria: (1) concurrent humeral arthroplasty, (2) primary glenohumeral OA, RA, (3) fracture, (4) osteonecrosis | Enrolled: 87 Analyzed: 87 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 87 Age, mean±SD (range): 62.5±9.5 yr (40.4–83.3 yr) Males %: 54 Cause of tear: NR Tear size: NR Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): NR Duration of immobilization: NR Duration of rehab: NR Rehab components: NR Rehab regime: NR PRE-OP TREATMENT: yes Duration: 12 mo (min) Type of treatment: physical therapy NOS, cortisone injection, NSAID | HRQL: • Health Utility Index • EuroQOL • SF-36 Function: NR Pain: NR ROM: NR Strength: NR Other: NR | Improvements were seen on the Health Utility Index, EuroQOL and SF-36 at 1 yr post-operative. An improvement in pain was seen in all measures. |
| Waibl B, 2005 Country: Switzerland Treatment category: Operative Questions: Q2, Q5 Funding: NR BA Quality: Consecutive: Y Followup: Y Outcome assessment: U | Recruitment dates: May 2001 to Apr 2002 Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 16 mo (11–22 mo) Inclusion criteria: (1) partial articular-side SS tendon avulsions, (2) 30–70% of tendon cross section Exclusion criteria: (1) significant bursal side tendon lesion, (2) hidden FTT | Enrolled: 22 Analyzed: 22 Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: PTT Tendon(s) torn: SS GROUP 1 N: 22 Age, mean±SD (range): 45 yr (20–63 yr) Males %: 54.5 Cause of tear: degenerative (12), traumatic (10) Tear size: NR Dominant shoulder %: NR Comorbidities: SLAP lesion (5); SC repair (1); acromial clavicular resection (4) | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (NR); SLAP repairs (5); SC repair (1); AC joint resection (4) Duration of immobilization: 6 wk. Duration of rehab: NR Rehab components: active-assisted stretching–immediately post operative Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • UCLA Pain: • VAS ROM: NR Strength: NR Other: NR | The transtendon suture technique for partial articular side SS tendon show promising results. |
| Walton JR, 2007 Country: Australia Treatment category: Operative augmentation Questions: Q2, Q5 Funding: No funding NOS: 6*/8* | Recruitment dates: Apr 2002 to Jan 2003 Study design: retrospective cohort Enrolled consecutively: no Followup duration, mean (range): 24 mo. Inclusion criteria: (1) poor tendon quality or large to massive FTT of a tendon that could be attached to the greater tuberosity after mobilization (2) intact SC tendon Exclusion criteria: NR | Enrolled: 31 (shld: 32) Analyzed: 31 (shld: 32) Withdrawals: 0 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 15 (shld: 16) Age, mean±SE: 60.2±3.5 Males %: 67 Cause of tear: NR Tear size: lg, mass Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 16 (shld: 16) Age, mean±SE: 59.6±3.1 Males %: 69 Cause of tear: NR Tear size: lg, mass Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty, augmentation Technique: side-to-side suture, tendon-to-bone reattachment & suture through graft in horizontal mattress configuration Duration of immobilization: 4 wks Duration of rehab: NR Rehab components: passive stretching–1–4 wks; active stretching & strengthening exercises–>4 wks Rehab regime: NR GROUP 2 Surgical approach: open Type of surgery: repair and debridement Additional procedures (N): acromioplasty Technique: side-to-side suture & tendon-to-bone reattachment Duration of immobilization: 4 wks Duration of rehab: NR Rehab components: passive stretching–1–4 wks; active stretching & strengthening exercises–>4 wks Rehab regime: NR PRE-OPERATIVE TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: NR Pain: • Activity pain scores ROM: NR Strength: • ER • IR • ADD • Lift-off • SS Other: • Participation in sports • Cuff integrity | Two years after surgical repair of large RC defect supplemented with xenograft, patients had persisting deficits and no recognizable benefit compared with the results of patients with no augmentation. The use of the orthobiologic implant is not recommended. |
| Warner JJ, 2005 Country: USA Treatment category: Operative approach Questions: Q2, Q5 Funding: NR NOS: 5*/8* | Recruitment dates: Jul 1999 to Jul 2000 Study design: retrospective cohort Enrolled consecutively: NR Followup duration, mean±SD (range): 4.2±0.3 yr (2.3–7.1 yr); Group 1: 3.7±1 yr; Group 2: 4.6±1.3 yr Inclusion criteria: (1) no previous surgery, (2) pain refractory >6 wk of physical therapy, (3) pain in overhead arm and impingement sign, (4) no superior translation of humeral head in AP radiograph, (5) no significant stiffness, (6) FTT limited to SS, no evidence of RC muscular atrophy Exclusion criteria: (1) prior surgery, (2) extention of tear to SC or IS, (3) concomitant stiffness | Enrolled: 21 Analyzed: 21 Withdrawals: 0 Duration since symptom onset, mean±SD (range): Group 1: 9±4 mo. (NR) Group 2: 12±4 mo. (NR) Type of tear: FTT Tendon(s) torn: SS GROUP 1 N: 12 Age, mean±SD (range): 55±8 yr. (NR) Males %: 66.7 Cause of tear: degenerative (6), traumatic (6) Tear size: NR Dominant shoulder %: NR Comorbidities: SLAP lesion (4); Bankart (0) GROUP 2 N: 9 Age, mean±SD (range): 53±10 yr. (NR) Males %: 55.6 Cause of tear: degenerative (3), traumatic (6) Tear size: NR Dominant shoulder %: NR Comorbidities: SLAP lesion (2); Bankart (1) | GROUP 1 Surgical approach: mini-open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenotomy (1); capsular release (1) Duration of immobilization: 4 wk Duration of rehab: NR Rehab components: passive stretching (wk 1–4); active stretching (wk 5–11); strengthening (≥12) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all); biceps tenotomy (3) Duration of immobilization: 4 wk Duration of rehab: NR Rehab components: passive stretching (wk 1–4); active stretching (wk 5–11); strengthening ( wk 12) Rehab regime: NR PRE-OP TREATMENT: yes Duration: 6 wk (min) Type of treatment: cortisone injection | HRQL: NR Function: NR Pain: • SST • VAS ROM: • flexion • external rotation Strength: • strengh (5 points) Other: NR | No difference was found in outcomes between arthorscopic RCR and mini-open RCR due to satisfaction of all pts with the procedure and no objective differences in outcome. The choice of approach is best based on surgeon or pt preference. |
| Wilson F, 2002 Country: USA Treatment category: Operative technique Questions: Q2, Q5 Funding: NR NOS: 5*/8* | Recruitment dates: Feb 1986 to May 1994 Study design: retrospective cohort Enrolled consecutively: NR Followup duration, mean (range): 5 yr (2–14 yr) Inclusion criteria: (1) FTT, pain, failed nonoperative tx Exclusion criteria: (1) PTT >5 cm, (2) major organ system disease | Enrolled: 100 Analyzed: 100 Withdrawals: 0 Duration since symptom onset, mean (range): Group 1: 11 mo (1 wk–6.0 yr) Group 2: 10.6 mo (2 wk–6.0 yr) Type of tear: FTT Tendon(s) torn: NR GROUP 1 N: 35 Age, mean±SD (range): 52 yr (20–69 yr) Males %: 77.1 Cause of tear: degenerative (7), traumatic (28) Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 65 Age, mean±SD (range): 52 yr (32–70 yr) Males %: 58.5 Cause of tear: degenerative (19), traumatic (46) Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (26) Technique: staple fixation Duration of immobilization: 3 wk Duration of rehab: NR Rehab components: passive stretching and physical therapy NOS (wk 3 or 4); strengthening (wk 6) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures: acromioplasty (65); clavicle resection (58) Technique: side-to-side suture anchor Duration of immobilization: 0 Duration of rehab: NR Rehab components: passive stretching and physical therapy NOS (wk 3/4); strengthening (wk 6) Rehab regime: NR PRE-OP TREATMENT: yes Duration: NR Type of treatment: NR | HRQL: NR Function: • UCLA Pain: NR ROM: NR Strength: NR Other: • cuff integrity | Satisfactory postoperative results and better overall functional results are obtained in patients with well healed RC tendons. The arthroscopic techniques have comparable results to the results of traditional open repair. |
| Yamada N, 2000 Country: Japan Treatment category: Nonoperative vs. operative Questions: Q4, Q6 Funding: NR NOS: 3*/8* | Recruitment dates: 1979 to 1999 Study design: retrospective cohort Enrolled consecutively: NR Followup duration, mean (range): 4 yr (12 mo–23 yr) Inclusion criteria: mass RC tears Exclusion criteria: NR | Enrolled: 40 Analyzed: 40 Withdrawals: 0 Duration since symptom onset, mean (range): Group 1: 44 mo (12 mo–11 yr); Group 2: 13 mo (1 mo–4.5 yr) Type of tear: FTT Tendon(s) torn: Group 1: SS, IS Group 2: NR GROUP 1 N: 14 Age, mean±SD (range): 70 yr (55–81 yr) Males %: 64.3 Cause of tear: NR Tear size: mass Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 26 Age, mean±SD (range): 62 yr (47–82 yr) Males %: 92.3 Cause of tear: NR Tear size: mass Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Intervention (modality): passive ROM, strengthening, corticosteroid injection, heat Drug name: lidocaine (4 ml); dexamethasone (2 mg) Duration of treatment: 15 injections (mean) Treatment Regime: Frequency–1–2/wk; Intensity–NR Degree of supervision: NR Treatment provider: NR GROUP 2 Surgical approach: open Type of surgery: unclear Additional procedures (N): acromioplasty (26); tenorrhaphy (12); muscle transfer (6); muscle transfer of TM (3); LHB (2) Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (day 3); active-assisted stretching (day 14–36); active stretching and strengthening (≥day 36) Rehab regime: NR | HRQL: NR Function: • JOA Pain: NR ROM: NR Strength: • flexion and extension • internal and external rotation Other: NR | The operative group experienced greater improvement in pain relief, muscle strength, and ROM than conservative group. Significantly better final result were seen in pts without rupture of the tendon of LHB. |
| Youm T, 2005 Country: USA Treatment category: Operative technique Questions: Q2, Q5, Q6 Funding: NR NOS: 6*/8* | Recruitment dates: Mar 1997 to Sep 2001 Study design: Retrospective cohort Enrolled consecutively: yes Followup duration, mean (range): 3.0 yr (2–5.8 yr) Inclusion criteria: (1) ≥2 yr. followup, (2) surgically confirmed and repaired RC tear Exclusion criteria: (1) previous RC surgery; (2) mass RC tear; (3) WCB; (4) loss of passive ROM, AC pint pathology; (5) intraarticular lesions; (6) GH arthritis; (7) SLAP lesion; (8) capsulolabral detachment | Enrolled: 95 Analyzed: 84 (shld: 84) Withdrawals: 11 Duration since symptom onset, mean (range): NR Type of tear: NR Tendon(s) torn: NR GROUP 1 N: 42 Age, mean±SD (range): 60 yr (NR) Males %: NR Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: NR GROUP 2 N: 42 Age, mean±SD (range): 57.9 yr (NR) Males %: NR Cause of tear: NR Tear size: sm, med, lg Dominant shoulder %: NR Comorbidities: NR | GROUP 1 Surgical approach: mini-open Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Technique: margin convergence sutures and anchors or bone tunnels Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (immediately); active stretching (wk 4–6) Rehab regime: NR GROUP 2 Surgical approach: all-arthroscopic Type of surgery: repair and debridement Additional procedures (N): acromioplasty (all) Technique: suture lassoes and suture punches; anchors Duration of immobilization: NR Duration of rehab: NR Rehab components: passive stretching (immediately); active stretching (wk 4–6) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • ASES • UCLA Pain: NR ROM: NR Strength: NR Other: NR | At 2 yr followup, arthroscopic and mini-open RCR produced similar results for small, medium and large RC tear with equivalent satisfaction rates. |
| Zumstein MA, 2008 Country: Switzerland Treatment category: Operative Questions: Q2, Q5, Q6 Funding: No funding BA Quality: Consecutive: Y Followup: Y Outcome assessment: Y | Recruitment dates: NR Study design: before-and-after Enrolled consecutively: yes Followup duration, mean (range): 9.9 yr (6.7–12.8 yr) Inclusion criteria: (1) open RCR of mass RC tears, (2) availability for followup Exclusion criteria: unavailability for follow | Enrolled: 27 Analyzed: 23 Withdrawals: 4 Duration since symptom onset, mean (range): NR Type of tear: FTT Tendon(s) torn: SS+SC, SS+IS, SS+IS+SC GROUP 1 N: 27 Age, mean±SD (range): 54 yr (42–67 yr) Males %: 55.6 Cause of tear: NR Tear size: mass Dominant shoulder %: 66.7 Comorbidities: NR | GROUP 1 Surgical approach: open Type of surgery: repair Additional procedures (N): NR Duration of immobilization: 6 wk. Duration of rehab: NR Rehab components: passive stretching (day 1–wk 6); active stretching (≥wk 6); strengthening (wk 12) Rehab regime: NR PRE-OP TREATMENT: NR Duration: NR Type of treatment: NR | HRQL: NR Function: • CMS • subjective shld value Pain: NR ROM: • abduction • flexion • external rotation • internal rotation Strength: • abduction Other: • intramuscular fatty degeneration • fatty infiltration • cuff integrity | Clinically durable, excellent results with high pt satisfaction were achieved by open RCR of mass RC tears at a mean of almost 10 yrs postoperative. However, fatty infiltration of SS + IS progressed, and retear size increased overtime. |
AC = acromioclavicular; ADL = activities of daily living; ant = anterior; ASES =American Shoulder and Elbow Scale; cm = centimeter; CCT = controlled clinical trial; CMS = Constant-Murley score; CPM = continuous passive motion; DASH = Disabilities of the Arm, Shoulder, and Hand; DM = diabetes mellitus; dx = diagnosis; ER = external rotation; FT-RC tear = full-thickness rotator cuff tear; FTT = full-thickness tear; hr = hour; HRQL = health-related quality of life; hx = history; Insalata = L‘Insalata Shoulder Rating Questionnaire; IR = internal rotation; IS = infraspinatus; lg = large; JOA = Japanese Orthopaedic Association; LHB = long head of biceps; mass = massive; max = maximum; med = medium; min = minimum; mm = millimeter; MRI = magnetic resonance imaging; mo = month; N = number; NA = not applicable; NOS = not otherwise specified; NR = not reported; NSAID = non-steroidal anti-inflammatory drugs; OA = osteoarthritis; OSS = Oxford Shoulder Score; PENN = University of Pennsylvania Shoulder Score; pos = posterior; post-op = post-operative; pre-op = preoperative; pt(s) = patient(s); PT = physical therapy; PTT = partial thickness tear; QOL = quality of life; RA = rheumatoid arthritis; RC tear = rotator cuff tear; RCR = rotator cuff repair; RCT = randomized controlled trial; rep = repetition; ROM = range of motion; sm = small; SC = subscapularis; SD = standard deviation; SE = standard error; SF-12 = Short-Form (12) Health Survey; SF-36 = Short-Form (36) Health Survey; sec = second; shld = shoulder; SLAP = superior labral from anterior to posterior; SPADI = Shoulder Pain and Disability Index; SS = supraspinatus; SST = simple shoulder test; TM = teres minor; tx = treatment; UCLA = University of California Los Angeles Scale; VAS = visual analog scale; WCB = workers’ compensation board; WORC Index = Western Ontario Rotator Cuff Index; yr = year
Alphabetical List of Included Studies
- 1.
- Audenaert E, Van NJ, Schepens A, et al. Reconstruction of massive rotator cuff lesions with a synthetic interposition graft: a prospective study of 41 patients. Knee Surg Sports Traumatol Arthrosc. 2006;14(4):360–364. [PubMed: 16252125]
- 2.
- Baker CL, Liu SH. Comparison of open and arthroscopically assisted rotator cuff repairs. Am J Sports Med. 1995;23(1):99–104. [PubMed: 7726359]
- 3.
- Baysal D, Balyk R, Otto D, et al. Functional outcome and health-related quality of life after surgical repair of full-thickness rotator cuff tear using a mini-open technique. Am J Sports Med. 2005;33(9):1346–1355. [PubMed: 16002486]
- 4.
- Bennett WF. Arthroscopic repair of massive rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Arthroscopy. 2003;19(4):380–390. [PubMed: 12671621]
- 5.
- Bennett WF. Arthroscopic repair of full-thickness supraspinatus tears (small-to-medium): a prospective study with 2- to 4-year follow-up. Arthroscopy. 2003;19(3):249–256. [PubMed: 12627148]
- 6.
- Bennett WF. Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up: classification of biceps subluxation/instability. Arthroscopy. 2003;19(1):21–33. [PubMed: 12522399]
- 7.
- Bigoni M, Gorla M, Guerrasio S, et al. Shoulder evaluation with isokinetic strength testing after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2009;18(2):178–183. [PubMed: 19111477]
- 8.
- Bishop J, Klepps S, Lo IK, et al. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg. 2006;15(3):290–299. [PubMed: 16679227]
- 9.
- Boehm TD, Werner A, Radtke S, et al. The effect of suture materials and techniques on the outcome of repair of the rotator cuff: a prospective, randomised study. J Bone Joint Surg Br. 2005;87(6):819–823. [PubMed: 15911666]
- 10.
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- Evidence Tables - Comparative Effectiveness of Nonoperative and Operative Treatm...Evidence Tables - Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
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