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Efficacy of surgery for rotator cuff tendinopathy: a systematic review

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Abstract

The objective of this study is to review randomized controlled trials evaluating the efficacy of surgery for the treatment of rotator cuff (RC) tendinopathy. Studies up to August 2013 were located in the PubMed, Embase, CINAHL, and PEDro databases using relevant keywords. Studies were included if: (1) participants had rotator cuff tendinopathy, (2) the trials were conducted on an adult population (≥18 years old), (3) at least one of the interventions studied was a surgical procedure, (4) study design was a randomized controlled trial (RCT), and (5) the article was written in English or French. Characteristics of the included studies were extracted using a standardized form. Two independent raters reviewed the methodological quality of the studies using the Risk of Bias Assessment tool developed by the Cochrane Collaboration Group. Differences were resolved by consensus. Fifteen trials met our inclusion criteria. After consensus, the mean methodological quality for all studies was 58.9 ± 10.8 %. In three out of four RCTs of moderate or low methodological quality, no significant difference in treatment effectiveness was observed between open or arthroscopic acromioplasty compared to exercises in the treatment of RC tendinopathy. Based on two studies of low or moderate methodological quality, no difference in treatment effectiveness was observed between arthroscopic and open acromioplasty. Two other RCTs of low to moderate quality, however, found that arthroscopic acromioplasty yielded better results in the short-term for shoulder range of motion in flexion but that both procedures were comparable in the long-term. One additional study favored open acromioplasty over arthroscopic acromioplasty for the treatment of RC tendinopathy. Based on low- to moderate-quality evidence, acromioplasty, be it open or arthroscopic, is no more effective than exercises for the treatment of RC tendinopathy. Low-grade evidence also suggests that arthroscopic acromioplasty may yield better results in the short-term for shoulder range of motion in flexion compared to open acromioplasty, but long-term results are comparable between the two types of surgery. More high-quality RCTs are required in order to provide comprehensive treatment guidelines to healthcare providers.

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References

  1. Bennell K, Wee E, Coburn S, Green S, Harris A, Staples M, Forbes A, Buchbinder R (2010) Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial. BMJ: Brit Med J 340

  2. Chard M, Hazleman R, Hazleman B, King R, Reiss B (1991) Shoulder disorders in the elderly: a community survey. Arthritis Rheum 34(6):766–769

    Article  PubMed  CAS  Google Scholar 

  3. Luime J, Koes B, Hendriksen I, Burdorf A, Verhagen A, Miedema H, Verhaar J (2004) Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheum 33(2):73–81

    Article  PubMed  CAS  Google Scholar 

  4. Neer CS (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg 54(1):41–50

    PubMed  Google Scholar 

  5. Seitz AL, McClure PW, Finucane S, Boardman ND III, Michener LA (2011) Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech 26(1):1–12

    Article  Google Scholar 

  6. Boykin RE, Heuer HJ, Vaishnav S, Millett PJ (2010) Rotator cuff disease–basics of diagnosis and treatment. Rheumatol Rep 2(1):e1

    Google Scholar 

  7. Donigan JA, Wolf BR (2011) Arthroscopic subacromial decompression: acromioplasty versus bursectomy alone—does it really matter? A systematic review. Iowa Orthop J 31:121

    PubMed  PubMed Central  Google Scholar 

  8. Taverna E, Battistella F, Sansone V, Perfetti C, Tasto JP (2007) Radiofrequency-based plasma microtenotomy compared with arthroscopic subacromial decompression yields equivalent outcomes for rotator cuff tendinosis. Arthrosc J Arthrosc Relat Surg: Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 23(10):1042–1051. doi:10.1016/j.arthro.2007.04.018

    Article  Google Scholar 

  9. Green MR, Christensen KP (1993) Arthroscopic versus open Bankart procedures: a comparison of early morbidity and complications. Arthrosc: J Arthrosc Relat Surg 9(4):371–374

    Article  CAS  Google Scholar 

  10. Mohtadi NG, Chan DS, Hollinshead R, Boorman R, Hiemstra L, Lo I, Hannaford H, Fredine J, Sasyniuk T, Paolucci EO (2012) An expertise-based randomised clinical trial comparing arthroscopic versus open stabilization for recurrent anterior shoulder instability: two-year post-operative disease-specific quality of life outcomes. J Bone Joint Surg Brit Vol 94(SUPP XXXVIII):166

    Google Scholar 

  11. Coghlan J, Buchbinder R, Green S, Johnston R, Bell S (2008) Surgery for rotator cuff disease. Cochrane Database Syst Rev 1 (3)

  12. Higgins J, Altman DG (2008) Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series: 187-241

  13. Carbonel I, Martinez AA, Calvo A, Ripalda J, Herrera A (2012) Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study. Int Orthop 36(9):1877–1883

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gartsman GM, O'Connor DP (2004) Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: a prospective, randomized study of one-year outcomes. J Should Elbow Surg 13(4):424–426

    Article  Google Scholar 

  15. Lapner PL, Sabri E, Rakhra K, McRae S, Leiter J, Bell K, MacDonald P (2012) A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg 94(14):1249–1257

    Article  PubMed  Google Scholar 

  16. Cho C-H, Song K-S, Jung G-H, Lee Y-K, Shin H-K (2012) Early postoperative outcomes between arthroscopic and mini-open repair for rotator cuff tears. Orthopedics 35(9):749

    Article  Google Scholar 

  17. Ko S-H, Friedman D, Seo D-K, Jun H-M, Warner JJ (2009) A prospective therapeutic comparison of simple suture repairs to massive cuff stitch repairs for treatment of small- and medium-sized rotator cuff tears. Arthrosc: J Arthrosc Relat Surg 25(6):583–589, e584

    Article  Google Scholar 

  18. Ma H-L, Chiang E-R, Wu H-TH, Hung S-C, Wang S-T, Liu C-L, Chen T-H (2012) Clinical outcome and imaging of arthroscopic single-row and double-row rotator cuff repair: a prospective randomized trial. Arthrosc: J Arthrosc Relat Surg 28(1):16–24

    Article  CAS  Google Scholar 

  19. Rubenthaler F, Ludwig J, Wiese M, Wittenberg RH (2003) Prospective randomized surgical treatments for calcifying tendinopathy. Clin Orthop Relat Res 410:278–284

    Article  PubMed  Google Scholar 

  20. Boehm T, Werner A, Radtke S, Mueller T, Kirschner S, Gohlke F (2005) The effect of suture materials and techniques on the outcome of repair of the rotator cuff: a prospective, randomised study. J Bone Joint Surg Brit Vol 87(6):819–823

    Article  CAS  Google Scholar 

  21. Murphy MA, Maze NM, Boyd JL, Quick DC, Buss DD (1999) Cost-benefit comparison: holmium laser versus electrocautery in arthroscopic acromioplasty. J Should Elbow Surg 8(3):275–278

    Article  CAS  Google Scholar 

  22. Van Holsbeeck E, DeRycke J, Declercq G, Martens M, Verstreken J, Fabry G (1992) Subacromial impingement: open versus arthroscopic decompression. Arthrosc: J Arthrosc Relat Surg 8(2):173–178. doi:10.1016/0749-8063(92)90032-7

    Article  Google Scholar 

  23. Brox JI, Staff PH, Ljunggren AE, Brevik JI (1993) Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome) [with consumer summary]. BMJ 307(6909):899–903

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  24. Brox JI, Gjengedal E, Uppheim G, Bøhmer AS, Brevik JI, Ljunggren AE, Staff PH (1999) Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 212-year follow-up. J Should Elbow Surg 8(2):102–111

    Article  CAS  Google Scholar 

  25. Haahr JP, Ostergaard S, Dalsgaard J, Norup K, Frost P, Lausen S, Holm EA, Andersen JH (2005) Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis 64(5):760–764

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  26. Haahr JP, Andersen JH (2006) Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4- to 8-years' follow-up in a prospective, randomized study. Scand J Rheumatol 35(3):224–228, 2006 May-Jun

    Article  PubMed  CAS  Google Scholar 

  27. Lindh M, Norlin R (1993) Arthroscopic subacromial decompression versus open acromioplasty. A two-year follow-up study. Clin Orthop Relat Res 290:174–176

    PubMed  Google Scholar 

  28. Norlin R (1989) Arthroscopic subacromial decompression versus open acromioplasty. Arthrosc: J Arthrosc Relat Surg 5(4):321–323

    Article  CAS  Google Scholar 

  29. Ketola S, Lehtinen J, Arnala I, Nissinen M, Westenius H, Sintonen H, Aronen P, Konttinen YT, Malmivaara A, Rousi T (2009) Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J Bone Joint Surg Bri Vol 91(10):1326–1334. doi:10.1302/0301-620x.91b10.22094

    Article  CAS  Google Scholar 

  30. Rahme H, Solem-Bertoft E, Westerberg CE, Lundberg E, Sorensen S, Hilding S (1998) The subacromial impingement syndrome. A study of results of treatment with special emphasis on predictive factors and pain-generating mechanisms. Scand J Rehabil Med 30(4):253–262

    Article  PubMed  CAS  Google Scholar 

  31. Henkus HE, de Witte PB, Nelissen RG, Brand R, van Arkel ER (2009) Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study. J Bone Joint Surg Brit Vol 91(4):504–510. doi:10.1302/0301-620x.91b4.21442

    Article  CAS  Google Scholar 

  32. Husby T, Haugstvedt JR, Brandt M, Holm I, Steen H (2003) Open versus arthroscopic subacromial decompression: a prospective, randomized study of 34 patients followed for 8 years. Acta Orthop Scand 74(4):408–414. doi:10.1080/00016470310017703

    Article  PubMed  Google Scholar 

  33. Ingvarsson T, Hagglund G, Johnsson R (1996) Anterior acromioplasty. A comparison of two techniques. Int Orthop 20(5):290–292

    Article  PubMed  CAS  Google Scholar 

  34. Sachs RA, Stone ML, Devine S (1994) Open vs. arthroscopic acromioplasty: a prospective, randomized study. Arthrosc: J Arthrosc Relat Surg: Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 10(3):248–254

    Article  CAS  Google Scholar 

  35. Spangehl MJ, Hawkins RH, McCormack RG, Loomer RL (2002) Arthroscopic versus open acromioplasty: a prospective, randomized, blinded study. J Should Elbow Surg / Am Should Elbow Surg 11(2):101–107. doi:10.1067/mse.2002.120915

    Article  Google Scholar 

  36. T'Jonck L, Lysens R, De Smet L, Bellemans J, Stoffelen D, Tirez B, Witvrouw E (1997) Open versus arthroscopic subacromial decompression: analysis of one-year results. Physiother Res Int: J Res Clin Phys Ther 2(2):46–61

    Article  Google Scholar 

  37. Todd KH, Funk KG, Funk JP, Bonacci R (1996) Clinical significance of reported changes in pain severity. Ann Emerg Med 27(4):485–489

    Article  PubMed  CAS  Google Scholar 

  38. Hanratty CE, McVeigh JG, Kerr DP, Basford JR, Finch MB, Pendleton A, Sim J The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. In: Seminars in arthritis and rheumatism, 2012. vol 3. Elsevier, pp 297-316

  39. Kromer TO, Tautenhahn UG, de Bie RA, Staal JB, Bastiaenen CH (2009) Effects of physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature. J Rehabil Med 41(11):870–880

    Article  PubMed  Google Scholar 

  40. Michener LA, Walsworth MK, Burnet EN (2004) Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. J Hand Ther 17(2):152–164

    Article  PubMed  Google Scholar 

  41. Desmeules F, Minville L, Riederer B, Côté CH, Frémont P (2004) Acromio-humeral distance variation measured by ultrasonography and its association with the outcome of rehabilitation for shoulder impingement syndrome. Clin J Sport Med 14(4):197–205

    Article  PubMed  Google Scholar 

  42. Checroun AJ, Dennis MG, Zuckerman JD (1997) Open versus arthroscopic decompression for subacromial impingement. A comprehensive review of the literature from the last 25 years. Bull Hosp Joint Dis New York NY 57(3):145–151

    Google Scholar 

  43. Muir SW, Corea CL, Beaupre L (2010) Evaluating change in clinical status: reliability and measures of agreement for the assessment of glenohumeral range of motion. N Am J Sports Phys Ther: NAJSPT 5(3):98

    PubMed  PubMed Central  Google Scholar 

  44. Aleem AW, Brophy RH (2012) Outcomes of rotator cuff surgery: what does the evidence tell us? Clin Sports Med 31(4):665–674

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic clinical research unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, QC, Canada

    Panagiota Toliopoulos, François Desmeules & Jennifer Boudreault

  2. School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada

    François Desmeules

  3. Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada

    Jean-Sébastien Roy & Pierre Frémont

  4. Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada

    Jean-Sébastien Roy

  5. Research Centre of the Laval University Hospital (CHU), Quebec, QC, Canada

    Pierre Frémont & Clermont E. Dionne

  6. School of Rehabilitation Science, McMaster University, IAHS, Hamilton, ON, Canada

    Joy C. MacDermid

  7. Population Health Research Unit (URESP), Research Centre of the Laval University Hospital (CHU), Quebec, QC, Canada

    Clermont E. Dionne

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  1. Panagiota Toliopoulos
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Correspondence to François Desmeules.

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Toliopoulos, P., Desmeules, F., Boudreault, J. et al. Efficacy of surgery for rotator cuff tendinopathy: a systematic review. Clin Rheumatol 33, 1373–1383 (2014). https://doi.org/10.1007/s10067-014-2563-9

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