Treatment of Chronic Rotator Cuff Tears
Rotator cuff repair is an option for patients with chronic, symptomatic full thickness tears.

Rationale
Our systematic review identified one Level III study46 that compared conservative to surgical treatment of rotator cuff tears. In this study, sixty patients treated without surgery were compared to seventy-seven with rotator cuff repair. Per this study, in group A, tears were non-traumatic in 73% of cases and traumatic in 27% of cases. In group B, tears were non-traumatic in 32% of cases and traumatic in 68% of cases. Statistically significant less pain on shoulder range of motion and at night was seen in those patients who had surgery as compared to those with conservative treatment. Eighty-one percent of the surgical patients reported excellent results as compared to thirty-seven percent with conservative treatment although the authors did not report statistical significance in this comparison. Because there was only one Level III study to support this recommendation, we also examined Level IV articles.

We identified multiple Level IV articles47-52 on the influence of advanced muscle disease on rotator cuff repair. Six studies47-52 assessed MRI tear characteristics of fatty infiltration and/or muscle atrophy on outcome. One study47 reported that patients undergoing open, mini-open or arthroscopic repairs of full thickness tears had fatty atrophy or infiltration of the infraspinatus that led to lower ASES scores. Atrophy and infiltration of the supraspinatus did not correlate with ASES scores. Another study51 reported that the degree of preoperative supraspinatus atrophy correlated with postoperative Constant-Murley scores. Constant-Murley scores in patients with greater atrophy were associated with poorer outcome. Another study48 did not show a statistically significant correlation between preoperative fatty infiltration and postoperative Constant-Murley score. A final study50 showed positive correlation between decreasing postoperative UCLA scores and greater preoperative muscle degeneration as assessed by MRI. While these studies in total suggest that greater post operative functional deficits may occur in the presence of more significant muscle disease, the overall positive outcome of the surgery still suggests that operative treatment of chronic rotator cuff tears is an option.

Because this recommendation is supported by a single Level III article and several Level IV articles, the strength of the evidence that supports it is limited.