Multiple Treatment Comparisons for Large and Massive Rotator Cuff Tears: A Network Meta-analysis.

BACKGROUND

There is no consensus about the best choice between all the options available for large and massive rotator cuff tear (mRCTs) management.

OBJECTIVE

To determine the comparative effectiveness of current treatment options for management of large and mRCTs.

DESIGN

Network meta-analysis.

SETTING

We searched the Cochrane systematic reviews, MEDLINE and EMBASE databases for all trials of adults with large and mRCTs that report preoperative and postoperative functional scores after an intervention option.

PATIENTS: The network meta-analysis included 20 trials with 1233 patients with 37.24 months follow-up.

INTERVENTIONS: Eight treatment options for management of large and mRCTs were compared.

MAIN OUTCOME MEASURES: The primary effectiveness outcome was the functional score.

RESULTS

This meta-analysis did not show statistically significant differences between conservative, partial repair, patch or platelet rich plasma (PRP) augmentation, reverse total shoulder arthroplasty, and complete repair. Latissimus dorsi (LD) transfer was ranked first for effectiveness [standardized mean difference (SMD): 2.17, 0.28-4.07] and debridement ranked last (SMD: -2.15, -3.13 to -1.17).

CONCLUSIONS

Latissimus dorsi transfer seems to be most effective for management of large and mRCTs, although some heterogeneity was observed in this network meta-analysis of full text reports. The choice of the operating technique depends on the patient's general health status and his expectations. When a decision has been reached to perform surgery, a repair, even if partial, should be attempted. Procedures involving biologic augmentation (eg, PRP) seem to convey no additional benefit while introducing more risk. Debridement alone should be avoided.