Rotator cuff tears (RCTs) are a common cause of shoulder pain and functional limitation, affecting approximately 30% of the population over 60 years. The incidence of RCTs is increasing worldwide due to the aging population and increased physical activity among older adults. The treatment of degenerative cuff tears remains a challenge for orthopedic surgeons, with no universally accepted standard of care. This systematic review and meta-analysis aims to compare the clinical and functional outcomes of conservative management versus surgical repair in the treatment of degenerative RCTs.

A comprehensive literature search was conducted on PubMed, Scopus, and Web of Science databases to identify all randomized trials comparing surgery to conservative management of degenerative rotator cuff tears. The quality of the trials was assessed using the Cochrane Risk of Bias Assessment. Data were extracted from each included study, including patient demographics, study design, follow-up times, treatment groups, evaluation scores, and overall clinical findings.

Seven studies, including 326 patients, were included in this study. Although surgery provided superior results in terms of Visual Analog Scale (VAS) and Constant score compared to conservative management at 1-year follow-up, this superiority did not reach the “minimal clinical important difference“. There is insufficient evidence about the role of surgery in preventing the progression of tendon wear due to limited data on long-term outcomes.

The results suggest that a proper rehabilitation program can provide similar results compared to surgery at a short-term follow-up in degenerative RCTs. However, further long-term data are necessary to understand if tendon repair might have a protective role towards worsening of degeneration, thus providing better clinical outcomes than conservative management.

Based on the available evidence, both conservative management and surgical repair can improve clinical and functional outcomes in patients with degenerative RCTs. However, the superiority of one approach over the other is not clear. Further research is needed to determine the best treatment approach for these patients, taking into account individual patient characteristics, the severity of the tear, and the patient’s functional demands and expectations.

Future research should focus on conducting high-quality randomized controlled trials with long-term follow-up to provide more definitive evidence on the best treatment approach for degenerative RCTs. Additionally, studies should also consider the cost-effectiveness of the different treatment options, as this is an important factor in decision-making for both patients and healthcare providers.