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Clinical Rheumatology

, Volume 33, Issue 10, pp 1373–1383 | Cite as

Efficacy of surgery for rotator cuff tendinopathy: a systematic review

  • Panagiota Toliopoulos
  • François DesmeulesEmail author
  • Jennifer Boudreault
  • Jean-Sébastien Roy
  • Pierre Frémont
  • Joy C. MacDermid
  • Clermont E. Dionne
Review Article

Abstract

The objective of this study is to review randomized controlled trials evaluating the efficacy of surgery for the treatment of rotator cuff (RC) tendinopathy. Studies up to August 2013 were located in the PubMed, Embase, CINAHL, and PEDro databases using relevant keywords. Studies were included if: (1) participants had rotator cuff tendinopathy, (2) the trials were conducted on an adult population (≥18 years old), (3) at least one of the interventions studied was a surgical procedure, (4) study design was a randomized controlled trial (RCT), and (5) the article was written in English or French. Characteristics of the included studies were extracted using a standardized form. Two independent raters reviewed the methodological quality of the studies using the Risk of Bias Assessment tool developed by the Cochrane Collaboration Group. Differences were resolved by consensus. Fifteen trials met our inclusion criteria. After consensus, the mean methodological quality for all studies was 58.9 ± 10.8 %. In three out of four RCTs of moderate or low methodological quality, no significant difference in treatment effectiveness was observed between open or arthroscopic acromioplasty compared to exercises in the treatment of RC tendinopathy. Based on two studies of low or moderate methodological quality, no difference in treatment effectiveness was observed between arthroscopic and open acromioplasty. Two other RCTs of low to moderate quality, however, found that arthroscopic acromioplasty yielded better results in the short-term for shoulder range of motion in flexion but that both procedures were comparable in the long-term. One additional study favored open acromioplasty over arthroscopic acromioplasty for the treatment of RC tendinopathy. Based on low- to moderate-quality evidence, acromioplasty, be it open or arthroscopic, is no more effective than exercises for the treatment of RC tendinopathy. Low-grade evidence also suggests that arthroscopic acromioplasty may yield better results in the short-term for shoulder range of motion in flexion compared to open acromioplasty, but long-term results are comparable between the two types of surgery. More high-quality RCTs are required in order to provide comprehensive treatment guidelines to healthcare providers.

Keywords

Acromioplasty Rotator cuff tendinopathy Shoulder Surgery Systematic review 

Notes

Disclosures

None.

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Copyright information

© Clinical Rheumatology 2014

Authors and Affiliations

  • Panagiota Toliopoulos
    • 1
  • François Desmeules
    • 1
    • 2
    Email author
  • Jennifer Boudreault
    • 1
  • Jean-Sébastien Roy
    • 3
    • 4
  • Pierre Frémont
    • 3
    • 5
  • Joy C. MacDermid
    • 6
  • Clermont E. Dionne
    • 5
    • 7
  1. 1.Orthopaedic clinical research unit, Maisonneuve-Rosemont Hospital Research CenterUniversity of Montreal Affiliated Research CenterMontrealCanada
  2. 2.School of Rehabilitation, Faculty of MedicineUniversity of MontrealMontrealCanada
  3. 3.Department of Rehabilitation, Faculty of MedicineLaval UniversityQuebec CityCanada
  4. 4.Centre for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityCanada
  5. 5.Research Centre of the Laval University Hospital (CHU)QuebecCanada
  6. 6.School of Rehabilitation ScienceMcMaster UniversityHamiltonCanada
  7. 7.Population Health Research Unit (URESP)Research Centre of the Laval University Hospital (CHU)QuebecCanada

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