BACKGROUND: Many approaches exist for managing rotator cuff tears.
PURPOSE: To compare the benefits and harms of nonoperative and operative 
interventions on clinically important outcomes in adults with rotator cuff 
tears.
DATA SOURCES: 12 electronic databases (1990 to September 2009), gray literature, 
trial registries, and reference lists were searched.
STUDY SELECTION: Controlled and uncontrolled studies that assessed nonoperative 
or operative treatments or postoperative rehabilitation for adults with 
confirmed rotator cuff tears were included. Operative studies in 
English-language publications and nonoperative and postoperative rehabilitation 
studies in English, French, or German were considered. Studies were assessed in 
duplicate.
DATA EXTRACTION: 2 reviewers assessed risk for bias by using the Cochrane Risk 
of Bias tool and the Newcastle-Ottawa Scale. One reviewer rated the evidence by 
using a modified GRADE (Grading of Recommendations Assessment, Development, and 
Evaluation) approach. Data were extracted by one reviewer and verified by 
another.
DATA SYNTHESIS: 137 studies met eligibility criteria. All trials had high risk 
for bias. Cohort and uncontrolled studies were of moderate quality. Reported 
functional outcomes did not differ between open versus mini-open repair, 
mini-open versus arthroscopic repair, arthroscopic repair with versus without 
acromioplasty, or single-row versus double-row fixation. Earlier return to work 
was reported for mini-open repair versus open repair and for continuous passive 
motion with physical therapy versus physical therapy alone. Open repairs showed 
greater improvement in function than did arthroscopic debridement. Complication 
rates were low across all interventions.
LIMITATIONS: Limited evidence, which was often of low quality, precluded 
conclusions for most comparisons. Language restrictions may have excluded some 
relevant studies, and selective outcome reporting may have introduced bias.
CONCLUSION: Evidence on the comparative effectiveness and harms of various 
operative and nonoperative treatments for rotator cuff tears is limited and 
inconclusive.
PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.