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Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft
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Multiple Treatment Comparisons for Large and Massive Rotator Cuff Tears: A Network Meta-analysis
Cédric Maillot1,2, Alice Martellotto3, Hugues Demezon1
1Department of Orthopaedics and Spine Surgery, Pellegrin Hospital, Bordeaux, France.
Summary
Latissimus dorsi transfer appears most effective for managing large and massive rotator cuff tears (mRCTs). Other surgical options like debridement alone should be avoided, while repair, even partial, is recommended when surgery is chosen.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanical Engineering
Background:
- Large and massive rotator cuff tears (mRCTs) lack a consensus on optimal management strategies.
- Current treatment options vary widely, leading to uncertainty in clinical decision-making.
Purpose of the Study:
- To conduct a comparative effectiveness analysis of various treatment options for large and massive rotator cuff tears.
- To identify the most effective interventions for improving functional outcomes in patients with mRCTs.
Main Methods:
- A network meta-analysis was performed, synthesizing data from 20 randomized controlled trials involving 1233 patients.
- Searches included major databases (MEDLINE, EMBASE, Cochrane reviews) for relevant studies reporting functional scores.
- Eight distinct treatment options were compared, focusing on preoperative and postoperative functional scores.
Main Results:
- Latissimus dorsi (LD) transfer demonstrated the highest effectiveness (SMD: 2.17) for mRCT management.
- Debridement was found to be the least effective option (SMD: -2.15).
- No statistically significant differences in effectiveness were observed between conservative management, partial repair, patch augmentation, platelet-rich plasma (PRP) augmentation, reverse total shoulder arthroplasty, and complete repair.
Conclusions:
- Latissimus dorsi transfer is suggested as the most effective surgical intervention for large and massive rotator cuff tears.
- While LD transfer shows promise, patient-specific factors and expectations should guide treatment selection.
- Surgical repair, even if partial, is advisable if surgery is pursued; procedures like debridement alone should be avoided, and biologic augmentations (e.g., PRP) offer no clear benefit.
