Indications for rotator cuff repair: a systematic review

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Rehabilitative Medicine

Background:

• Surgical repair of rotator cuff tears is common, yet evidence guiding surgical indications and timing is limited.
• Symptomatic, full-thickness rotator cuff tears present a challenge for optimal treatment decision-making.

Purpose of the Study:

• To systematically review the literature on factors influencing surgical repair decisions for symptomatic, full-thickness rotator cuff tears.
• To investigate the impact of demographic variables, symptom duration, surgical timing, physical findings, and tear size on treatment outcomes.

Main Methods:

• Systematic literature review of the best available evidence.
• Analysis of factors including patient demographics, symptom duration, surgical timing, physical examination findings, and rotator cuff tear size.

Main Results:

• Earlier surgical intervention may be indicated for patients experiencing weakness and significant functional disability.
• Demographic variables show unclear associations with treatment outcomes; older age does not appear to negatively impact results.
• Pending worker's compensation claims are associated with poorer treatment outcomes.

Conclusions:

• Current evidence provides some guidelines for surgical decision-making in rotator cuff tears, suggesting earlier intervention in cases of weakness and disability.
• Further high-quality research is necessary to establish definitive indications for surgical repair of full-thickness rotator cuff tears.
• Conducting ethical Level I evidence studies for rotator cuff tear surgery indications presents significant challenges.