Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, UK.
Br Med Bull. 2013;105:107-38. doi: 10.1093/bmb/lds029. Epub 2012 Oct 18.
There is a high rate of recurrence of tear and failed healing after rotator cuff repair. Several strategies have proposed to augment rotator cuff repairs to improve postoperative outcome and shoulder performance. We systematically review the literature on clinical outcome following rotator cuff augmentation.
We performed a comprehensive search of Medline, CINAHL, Embase and the Cochrane Central Registry of Controlled Trials, from inception of the database to 20 June 2012, using various combinations of keywords. The reference lists of the previously selected articles were then examined by hand. Only studies focusing on clinical outcomes of human patients who had undergone augmented rotator cuff repair were selected. We then evaluated the methodological quality of each article using the Coleman methodology score (CMS), a 10 criteria scoring list assessing the methodological quality of the selected studies (CMS).
Thirty-two articles were included in the present review. Two were retrospective studies, and 30 were prospective. Biologic, synthetic and cellular devices were used in 24, 7 and 1 studies, respectively. The mean modified Coleman methodology score was 64.0.
Heterogeneity of the clinical outcome scores makes it difficult to compare different studies.
None of the augmentation devices available is without problems, and each one presents intrinsic weaknesses. There is no dramatic increase in clinical and functional assessment after augmented procedures, especially if compared with control groups.
More and better scientific evidence is necessary to use augmentation of rotator cuff repairs in routine clinical practice.
肩袖修复后撕裂和愈合失败的复发率很高。已经提出了几种策略来增强肩袖修复，以改善术后结果和肩部功能。我们系统地回顾了关于肩袖增强后临床结果的文献。
我们使用各种关键词组合，对 Medline、CINAHL、Embase 和 Cochrane 中央对照试验登记处进行了全面搜索，从数据库建立到 2012 年 6 月 20 日。然后，通过手工检查先前选定文章的参考文献列表。仅选择了关注接受增强肩袖修复的人类患者临床结果的研究。然后，我们使用 Coleman 方法评分（CMS）评估每个文章的方法学质量，这是一个评估所选研究方法学质量的 10 项评分列表（CMS）。
目前的综述共纳入了 32 篇文章。其中 2 篇为回顾性研究，30 篇为前瞻性研究。生物、合成和细胞设备分别在 24、7 和 1 项研究中使用。改良的 Coleman 方法评分平均为 64.0。
临床结果评分的异质性使得比较不同的研究变得困难。
目前可用的增强设备都存在问题，每种设备都存在固有弱点。与对照组相比，增强手术后的临床和功能评估并没有明显增加。
需要更多和更好的科学证据才能将肩袖修复的增强用于常规临床实践。
