The optimal treatment for stage 2-3 Goutallier rotator cuff tears: A systematic review of the literature.

Fatty infiltration is an important prognostic factor for cuff healing after rotator cuff repair. Treatment options for stage 2-3 Goutallier rotator cuff tears vary widely and there is lack of decent comparative studies.

Purposes: The objective of this study was 1) to give an overview of the treatment options of stage 2-3 Goutallier rotator cuff tears and their clinical outcome and 2) to give a recommendation of the optimal treatment within this specific subgroup.

Methods: We searched the databases of Medline, Embase, Cochrane library, NHS Centre for Reviews and Dissemination, PEDro from inception to December 12th, 2016. Two authors, F.H. and N.W., selected the studies after consensus. Data was extracted by one author (F.H.) and checked for completeness by a second author (N.W.). Our primary outcome was physical function, measured by shoulder-specific patient reported outcomes. Secondary outcomes were cuff integrity after rotator cuff repair, shoulder pain, general health, quality of life, activity level and adverse events.

Results: For the first research question 28 prospective as well as retrospective studies were included. For the clinical outcome of these treatments three randomized controlled trials were included.

Conclusions: Despite the high reported retear rate, rotator cuff repair has comparable results (clinical improvement) as partial repair and isolated bicepstenotomy or tenodesis. These findings suggest that the additional effect of rotator cuff repair compared to the less extensive treatment options like isolated bicepstenotomy or tenodesis should be studied, as these might form a good alternative treatment based on this systematic review.

Level of evidence: Level IV; systematic review.