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We aim to complete a ‘best evidence synthesis’ to examine all high quality evidence available across the treatment spectrum for patients presenting with partial-thickness rotator cuff tears (PTRCTs) using a standardized framework.[1,2] A best evidence synthesis uses exhaustive search strategies from systematic review literature procedures. When possible, effect sizes from studies are quantified and used to characterize study outcomes similar to what is performed in a meta-analysis. Our best evidence synthesis will ensure strong methodological rigor, limiting the inclusion of poor quality or non-clinical studies, to aid informed decision-making,[1,2] Therefore, the goal of this project is to examine the evidence to garner a nonoperative vs surgical comparison that will allow patients and providers the ability to determine current best practice treatment for PTRCTs. Optimal treatment of PTRCTs is multifactorial and may be influenced by factors including the patient’s age, symptoms, functional deficit, size of tear, tear location (e.g. bursal vs articular), nature of onset (traumatic vs atraumatic), etiology, treatment timeline, concomitant pathologies (i.e. labral tear), comorbidities (i.e. diabetes), risk factors (i.e. smoker), and vocation and avocation activities.[3] Therefore, a secondary goal will be to identify factors that may identify which patients are best suited for an initial trial of nonoperative treatment or expedited surgical management, and which factors may be predictors of poor treatment outcomes. For example, depending on injury severity and job characteristics, working class individuals with PTRCTs may be likely to take time off work due to disability.[4] Understanding the relationship between patient/injury factors and appropriate treatment pathways may potentially reduce time off work for these individuals. The primary objective of our best evidence synthesis is to consolidate the existing HIGH-QUALITY evidence on best management approaches in treating patients presenting with PTRCTs including both nonoperative and surgical approaches. This will allow us to scrutinize the level of evidence available to provide meaningful recommendations. Our secondary objective is to explore the impact of baseline characteristics (e.g. age, sex, hand dominance, chronicity, general health status, tear characteristics, mechanism of injury, occupation type, occupational demands) and treatment characteristics (e.g. timing of intervention) on treatment success. With a focus on finding the best evidence, we will only include Level I studies to complete our primary objective. For our secondary objective, to gain a wider perspective, we will inform our recommendations with Level I and Level II evidence. Our best evidence synthesis will inform evidence-based decision-making on the best management plan for patients presenting with PTRCTs. We believe that appropriate recommendations will improve patient-oriented and clinical outcomes, and reduce inappropriate decision-making to facilitate efficient return-to-work and avoidance of surgery where possible. |
