ARTIGO DO MÊS (3/2009)

Indications for Surgery in Clinical Outcome Studies of Rotator Cuff Repair

Marx, R.G.; Koulouvaris, P.; Chu, S.K.; Levy, B.A.

Clin Orthop Relat Res (2009) 467:450–456

Abstract:

Full-thickness tears of the rotator cuff are common, but there is no clear consensus regarding indications for rotator cuff surgery.

Because some patients with full-thickness rotator cuff tears who are asymptomatic or symptomatic can be successfully treated nonoperatively, clinical outcome studies of rotator cuff repair should describe the subjects in detail to allow appropriate interpretation of the results. However, we hypothesized the indications for surgery are poorly described in outcome studies of rotator cuff surgery.

We undertook a detailed literature review over 11 years of six major orthopaedic journals to assess whether the indications for surgery were described adequately in studies of rotator cuff repair. Eighty-six papers fit the criteria for the study and were reviewed. Limitations of activities of daily living (31%), failure of nonoperative treatment (52%), duration of nonoperative treatment (26%), and history of nocturnal pain (16%) were reported in a minority of papers overall. The patients' characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair. It is important for these factors to be considered and reported because, without this information, the reasons for and results of rotator cuff repair are difficult to interpret.
Level of Evidence: Level III, prognostic study.

Some key-points

Factors generally believed to affect outcome, and therefore the decision to perform elective rotator cuff repair, include size of the tear, duration of symptoms, failure of nonoperative treatment, duration of nonoperative treatment, nocturnal pain, history of trauma, and limitations of activities of daily living (ADL), not necessarily in that order.
(acrescentava a idade e as exigências funcionais do paciente)

Without detailed knowledge of these factors before surgery, it is difficult to interpret the outcome of the operation.

Nonoperative treatments such as physical therapy, NSAIDs, and steroid injections have beneficial effects for some patients with rotator cuff tears.

Without attempting nonoperative treatment for appropriate patients, there is the potential for patients whose rotator cuff problems could have been improved with nonoperative treatment to have had unnecessary surgery.

(desde que seja uma intervenção adequada à resolução das causas pathomecânicas, fisiopatológicas e disfunções do controle neuromuscular da condição).

http://www.ncbi.nlm.nih.gov/entrez/query.fcgicmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18949526

Raul Oliveira, Fisioterapeuta
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