Conservative Treatments May Show No Significant Differences for Partial-Thickness Rotator Cuff Tears: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.

Abstract

To evaluate pain relief, functional recovery, and tear size progression following different conservative treatments for partial-thickness rotator cuff tears. This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Data sources including PubMed, the Cochrane Library, Embase, Scopus, and Web of Science were searched from January 1, 2005, to December 30, 2024. The search strategy employs the terms (rotator cuff AND (tear OR injury)) AND (partial OR incomplete). Only randomized controlled trials investigating conservative treatments specifically for partial-thickness rotator cuff tears are included. The revised Cochrane risk-of-bias tool for randomized controlled trials (RoB 2) was utilized to assess the methodological quality. Sixteen studies were included in the network meta-analysis. The network meta-analysis results comprised mean improvements in Visual Analog Scale, American Shoulder and Elbow Surgeons score, and Constant-Murley score at various follow-up time points. Platelet-rich plasma (PRP) was the most frequently reported conservative treatment, followed by steroids, sodium hyaluronate, and normal saline. When compared with normal saline, other conservative treatments showed no statistically significant differences in mean improvements across the three scoring systems at different follow-up periods. Subgroup analysis restricted to Level I randomized controlled trials or subacromial injection studies yielded similar network meta-analysis results. Both rank probability plots and cumulative probability rankings consistently identified the combination of PRP and sodium hyaluronate as the highest-ranked treatment. The results regarding tear size could not be pooled for analysis due to substantial heterogeneity across studies, although PRP appeared to show a potential for promoting tear healing. PRP represents the most frequently reported conservative treatment for partial-thickness rotator cuff tears. Compared with normal saline, none of the conservative therapies show statistically significant improvements in pain relief or functional recovery across all follow-up periods. Level II, systematic review and network meta-analysis of Level I and II randomized controlled trials.