Treatment of Rotator Cuff Tears: A Systematic Review and Meta-Analysis.

There is ongoing controversy regarding optimal treatment for full-thickness rotator cuff tears. Given that the evidence surrounding the use of various treatment options has expanded, an overall assessment is required.The following were compared to determine which resulted in improved patient-reported function, pain, and re-operation rates for each: 1) Double row (DR) fixation and single row (SR) fixation in arthroscopic cuff repair; 2) Latissimus dorsi transfer (LDT) with lower trapezius transfer (LTT), partial rotator cuff repair; and superior capsular reconstruction (SCR) 3) Early and late surgical intervention.Medline, Embase, and Cochrane were searched through to April 20, 2021. Additional studies were identified from reviews. The following were included: 1) All English-language randomized trials (RCT) in patients 18 years of age or older comparing SR and DR fixation, 2) observational studies comparing LDT with LTT, partial repair, and SCR, and 3) observational studies comparing early versus late treatment of full-thickness rotator cuff tears.A total of 15 RCTs (n=1096 randomized patients) were included in the meta-analysis of SR versus DR fixation. No significant standardized mean differences in function (0.08, 95%CI -0.09 - 0.24) or pain (-0.01, 95CI -0.52 - 0.49) were observed. There was a difference in re-tear rates in favor of DR compared with SR fixation (RR 1.56, 95%CI 1.06 - 2.29). Four studies were included in the systematic review of LDT compared with a surgical control. LDT and partial repair did not reveal any differences in function (-1.12, 95%CI -4.02 - 1.78) upon comparison. A single study compared arthroscopically assisted LDT to LTT and observed a non-statistical difference in the Constant score of 14.7 (95%CI -4.06 - 33.46). A single RCT compared LDT with SCR and revealed a trend toward superiority for the Constant score with SCR with a mean difference of -9.6 (95%CI -19.82 - 0.62). Comparison of early versus late treatment revealed a paucity of comparative studies with varying definitions of 'early' and 'late' treatment which made meaningful interpretation of the results difficult.DR fixation leads to similar improvement in function and pain compared with SR fixation and results in a higher healing rate. LDT transfer yields similar results to partial repair, LTT, and SCR in functional outcomes. Further study is required to determine the optimal timing of treatment and to increase confidence in these findings. Future trials of high methodological quality comparing LDT with LTT and SCR are required.