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The natural history of full-thickness rotator cuff tears in randomized controlled trials : a systematic review and meta-analysis
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Khatri, Chetan, Ahmed, Imran, Parsons, Helen, Smith, Nicholas A., Lawrence, Tom, Modi, Chetan S., Drew, Stephen J., Bhabra, Gev, Parsons, Nicholas R., Underwood, Martin and Metcalfe, Andrew J. (2018) The natural history of full-thickness rotator cuff tears in randomized controlled trials : a systematic review and meta-analysis. The American Journal of Sports Medicine . doi:10.1177/0363546518780694
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Official URL: https://doi.org/10.1177/0363546518780694
Abstract
Background: Rotator cuff tears are the commonest tendon injury in the adult population, resulting in substantial morbidity. The optimum management for these patients is not known.
Purpose: To assess the overall treatment response to all interventions in full-thickness rotator cuff tears in patients enrolled in randomised clinical trials.
Study Design: Systematic review and meta-analysis.
Methods: Randomised controlled trials (RCTs) were identified from a systematic search of Medline, Embase and CINAHL databases. Patients aged 18 or over with full-thickness rotator cuff tear. The primary outcome measure was change of Constant shoulder score from baseline at 52 weeks. A meta-analysis to assess treatment response was calculated using the standardised mean change in scores.
Results: We included 57 RCTs. The pooled standardised mean change, compared to baseline was: 1.42 (95% CI 0.80-2.04) at 3 months, 2.73 (95% CI 1.06-4.40) at 6 months and 3.18 (95% CI 1.64-4.71) at 12 months. Graphical plots of treatment response demonstrate a sustained improvement in outcomes in both non-operative trial arms and all operative sub-group arms.
Conclusions: Patients with full-thickness rotator cuff tears demonstrated a consistent pattern of improvement in Constant score with both conservative and operative care. The natural history of patients with rotator cuff tears included in RCTs is to improve over time, whether treated operatively or non-operatively.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine > RC1200 Sports Medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Shoulder joint -- Rotator cuff -- Wounds and injuries, Shoulder joint -- Rotator cuff -- Wounds and injuries -- Treatment, Clinical trials | ||||||
| Journal or Publication Title: | The American Journal of Sports Medicine | ||||||
| Publisher: | Sage Publications Ltd. | ||||||
| ISSN: | 0363-5465 | ||||||
| Official Date: | 2 July 2018 | ||||||
| Dates: |
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| DOI: | 10.1177/0363546518780694 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access |
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