Degenerative rotator cuff tears are a common cause of shoulder pain and disability. The treatment of these tears is complex due to the variety of available options, which include non-operative management, surgical repair, and shoulder replacement. The provided PDF, titled “Treatment of Degenerative Rotator Cuff Tears: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials“ by Lambers Heerspink et al., provides a comprehensive review of the current evidence for these treatment options.

Non-operative treatment, such as physical therapy, is often the first line of treatment for degenerative rotator cuff tears. However, the effectiveness of this approach is variable and depends on factors such as the size and location of the tear, patient age, and patient activity level. The study found that 60% of patients did not respond to physical therapy or went on to have surgery.

Surgical repair of degenerative rotator cuff tears can be performed using various techniques, including débridement, partial repair, graft interposition, and tendon transfer. The study found that débridement and partial repair showed improvements in pain scores, functional range of motion, and patient-reported outcome scores, with lower reoperation rates compared to physical therapy. However, partial repair was associated with a high re-tear rate (45%).

Shoulder replacement, specifically reverse shoulder arthroplasty, is another treatment option for degenerative rotator cuff tears. This approach was found to improve pain scores, functional motion, and patient-reported outcome scores compared to physical therapy. However, this treatment strategy has an 8.2% reoperation rate and a 10.1% prosthesis failure rate.

A recent meta-analysis titled “Comparative Efficacy of Nonoperative and Operative Treatments for Rotator Cuff Tears: A Network Meta-analysis of Randomized Controlled Trials“ found that surgical reconstruction (graft interposition / tendon transfer) showed superior improvements in pain scores, forward elevation, and mean change in Constant-Murley Score (CMS) and American Shoulder and Elbow Surgeons (ASES) scores compared to physical therapy.

The treatment of degenerative rotator cuff tears is complex and should be individualized based on patient factors, tear characteristics, and shared decision-making between the patient and surgeon. While surgical repair and shoulder replacement can provide significant improvements in pain and function, these procedures are also associated with potential complications and reoperation rates. Further high-quality research is needed to guide the management of these challenging cases.