Arthroscopic and open repair of massive rotator cuff tears have similar results: a systematic review

Abstract

Importance The surgical outcomes of massive rotator cuff tears (MRCTs) repair are poorly reported in the scientific literature.

Objective This study aimed to evaluate the reported outcomes of open or arthroscopic repair of MRCTs.

Evidence review We comprehensively searched the Medline, Scopus, Cochrane Database of Systematic Reviews and CENTRAL databases up to January 2017. We included studies with a prospective design assessing the outcomes of open or arthroscopic repair of MRCTs, with a minimum of 1 year of follow-up. We excluded studies in which subgrouping of massive tears was not possible. We assessed the methodological quality of the studies using the Coleman methodology score.

Findings We included 12 studies (comprising 990 patients, 511 of whom had an MRCT): eight reported the arthroscopic rotator cuff repair outcomes, two reported open repair and the other two reported the outcomes of both techniques. The mean follow-up time was 57 months (range 12–108). A quantitative synthesis of the arthroscopic rotator cuff repair results showed clinical improvements in the Constant and American Shoulder and Elbow Surgeons scores from preoperatively to postoperatively. Comparing the arthroscopic and open repair procedures, we observed similar pooled weighted means for the Constant, University of California, Los Angeles and American Shoulder and Elbow Surgeons scores at 26–56 months of follow-up.

Conclusions and relevance Both arthroscopic and open repair produced similar and improved postoperative outcomes to those preoperatively. MRCT repair requires further research and better reporting to obtain stronger conclusions.

Level of evidence Level II, systematic review and meta-analysis.