Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response.

BACKGROUND: There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic review and meta-analysis was to (1) compare patient-reported outcome scores, (2) define failure and reoperation rates, and (3) quantify the magnitude of patient response across treatment strategies. METHODS: The MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus databases were searched for studies including physical therapy and operative treatment of massive rotator cuff tears. The criteria of the Methodological Index for Non-randomized Studies were used to assess study quality. Primary outcome measures were patient-reported outcome scores as well as failure, complication, and reoperation rates. To quantify patient response to treatment, we compared changes in the Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score with previously reported minimal clinically important difference (MCID) thresholds. RESULTS: No level I or II studies that met the inclusion and exclusion criteria were found. Physical therapy was associated with a 30% failure rate among the included patients, and another 30% went on to undergo surgery. Partial repair was associated with a 45% retear rate and 10% reoperation rate. Only graft interposition was associated with a weighted average change that exceeded the MCID for both the Constant-Murley score and ASES score. Latissimus tendon transfer techniques using humeral bone tunnel fixation were associated with a 77% failure rate. Superior capsular reconstruction with fascia lata autograft was associated with a weighted average change that exceeded the MCID for the ASES score. Reverse arthroplasty was associated with a 10% prosthesis failure rate and 8% reoperation rate. CONCLUSION: There is a lack of high-quality comparative studies to guide treatment recommendations. Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate.

Radiographic comparison of pegged and keeled glenoid components using modern cementing techniques: a prospective randomized study.

BACKGROUND: Modern cementing techniques have improved glenoid fixation, reduced glenoid lucency seen with keeled components, and may eliminate differences attributable to glenoid design. The purpose of this study was to determine the effect of glenoid design on immediate and follow-up radiographic lucency of pegged and keeled glenoid components, using modern cementing techniques. MATERIAL AND METHODS: Fifty-three total shoulder arthroplasties were performed in patients with primary glenohumeral osteoarthritis. Patients were randomized prospectively to receive either a pegged or keeled glenoid component. Three raters graded radiographic glenoid lucencies. RESULTS: On immediate radiographs, there was no significant difference in the rate of glenoid lucency between pegged (0%) and keeled (15%) glenoid components (P = .128). However, after an average of 26 months, the rate of glenoid lucency was significantly higher in patients with keeled components (46%) compared to patients with pegged components (15%) (P = .003). CONCLUSION: Even with modern cementing techniques, pegged glenoid components remain radiographically superior to keeled glenoid components.