The following key questions (KQ) were investigated for a population of adult patients with partial- and full-thickness RC tears:
1. Does early surgical repair compared to late surgical repair (i.e., nonoperative intervention followed by surgery) lead to improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
2. What is the comparative effectiveness of operative approaches (e.g., open surgery, mini-open surgery, and arthroscopy) and postoperative rehabilitation on improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
* Which operative approach should be used for different types of tears (e.g., partial-thickness or full-thickness; small, medium, large, or massive; with or without fatty infiltration of muscle tissue)?
3. What is the comparative effectiveness of nonoperative interventions on improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength? Nonoperative interventions include, but are not limited to, exercise, manual therapy, cortisone injections, acupuncture, and treatments and modalities typically delivered by physical therapists, osteopaths, and chiropractors.
* Which nonoperative treatment approach should be used for different types of tears (e.g., partial-thickness, full-thickness; small, medium, large, or massive; with or without fatty infiltration of muscle tissue)?
4. Does operative repair compared with nonoperative treatment lead to improved health-related quality of life, decreased disability, reduced time to return to work/activities, higher rate of cuff integrity, less shoulder pain, and increased range of motion and/or strength?
5. What are the associated risks, adverse effects, and potential harms of nonoperative and operative therapies?
6. Which demographic (e.g., age, gender, ethnicity, comorbidities, workers’ compensation claims) and clinical (e.g., size/severity of tear, duration of injury, fatty infiltration of muscle) prognostic factors predict better outcomes following nonoperative and operative treatment?
* Which (if any) demographic and clinical factors account for potential differences in surgical outcomes between patients who undergo early versus delayed surgical treatment?
Source: Summary of strength of evidence for nonoperative and operative interventions for RC tears
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