Current Evidence, Challenges, Opportunities, and Future Directions of Rotator Cuff Failure: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Medicine
• Sports Medicine

Background:

• Rotator cuff tears (RCTs) are a leading cause of musculoskeletal disability globally.
• Pathophysiology involves mechanical stress, degeneration, and biological deterioration, leading to pain and functional loss.
• Optimal treatment selection is crucial before irreversible damage occurs.

Purpose of the Study:

• To systematically review evidence on rotator cuff tear etiology, diagnosis, and management.
• To compare functional outcomes of conservative versus surgical interventions.
• To assess emerging rehabilitation adjuncts for rotator cuff failure.

Main Methods:

• Systematic review adhering to PRISMA 2020 guidelines.
• Search of PubMed, Google Scholar, Scopus, and Cochrane Library.
• Inclusion of RCTs and cohort studies; quality assessment using RoB2 and ROBINS-I tools.

Main Results:

• Equivalent functional outcomes for conservative care and surgical repair in small-to-medium degenerative tears.
• Functional benefit of physical therapy plateaus after 16 sessions.
• Arthroscopic repair shows comparable outcomes to open surgery with less morbidity.

Conclusions:

• Individualized, milestone-driven management is optimal for rotator cuff failure.
• Conventional therapy is a first-line treatment, with timely transition to surgery if milestones are unmet.
• Emerging rehabilitation modalities enhance pain modulation, range of motion, and adherence.