Comparison of nonsurgical treatment approaches for partial rotator cuff tears: a systematic review and meta-analysis

Rotator cuff disease constitutes the most common cause of shoulder pain, accounting for up to 70% of shoulder-related complaints, with partial-thickness rotator cuff tears (PT-RCTs) representing a substantial proportion. Although nonsurgical interventions are generally recommended as first-line treatment, there is currently no consensus on the optimal nonsurgical management of symptomatic PT-RCTs. This study aims to determine the effectiveness of different nonsurgical treatment modalities for PT-RCTs, specifically comparing physical therapy (PT) and injection therapies.

A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. Eligible studies on nonsurgical interventions for PT-RCTs in adults (≥18a) were included. Clinical outcomes (Constant Score (CS), American Shoulder and Elbow Surgeon (ASES) score, and visual analog scale were analyzed using random-effects meta-analysis and descriptive statistics to outline study characteristics.

From 9,894 records screened, 22 studies with 1,137 patients were included. PT was statistically superior to injection therapy in the CS (P = .0001). Among injections, cell-based therapies outperformed non-cell-based injections in the CS (P = .01) and exceeded Minimally Clinically Important Difference (MCID) for both the CS and ASES, indicating both statistical and clinical significance. Non-cell-based injections and PT show statistical significance in the CS (P < .001), with intervention groups outperforming control groups. Non-cell-based injections also surpass the clinical threshold in the CS (mean difference = 19.11), showing both statistical and clinical significance.

In PT-RCTs, PT shows statistically superior outcomes to injection therapy in the CS. Cell-based injections outperform non-cell-based injections in the CS and exceed MCID in both, the CS and ASES scores, indicating clinical relevance. Both experimental groups for non-cell-based injections and PT show statistical significance in the CS, with non-cell-based injections surpassing the MCID in the CS. These findings highlight the effectiveness of PT and cell-based injections as nonsurgical options, but treatment should be individualized, as no single approach proved clearly superior across all outcomes.