Partial rotator cuff repair versus debridement for irreparable rotator cuff tears: A systematic review.

Abstract

Massive irreparable rotator cuff tears (MIRCT) are a significant cause of shoulder disability and pain, presenting a unique challenge in terms of management with multiple options for care ranging from debridement alone to partial rotator cuff repair. In this study we investigate how clinical outcomes and complications of partial rotator cuff repair compare to simple debridement in the treatment of irreparable rotator cuff tears. A total of 1594 publications were identified on PubMed from 1946 to 2017 with 16 level III to level IV studies that were reviewed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 709 shoulders from 706 patients were reviewed, with 380 patients receiving a partial repair and 329 shoulders receiving debridement. Fifteen outcome measures were utilized with visual analog scale (VAS) pain score and patient satisfaction being the most common. Pre- and post-operative mean VAS scores reported in 155 shoulders treated with partial repair were 6.0 (5.1-6.9) and 2.0 (1.7-3.2), respectively. Pre- and post-operative mean VAS scores in 113 shoulders treated with debridement were 6.5 (4.5-7.9) and 1.9 (1-2.9), respectively. Patient satisfaction in 111 shoulders treated with partial repair was reported as 75 % (51.6-92). In 153 shoulders treated with debridement, post-operative satisfaction was 80.7 % (78-83.9). This systematic review study demonstrates that both partial repair and debridement alone can result in acceptable clinical outcomes with no significant differences noted for patients with irreparable rotator cuff tears in short to mid-term follow up.