Makhni Eric C, Steinhaus Michael E, Morrow Zachary S, Jobin Charles M, Verma Nikhil N, Cole Brian J, Bach Bernard R
Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
J Shoulder Elbow Surg. 2015 Dec;24(12):2008-15. doi: 10.1016/j.jse.2015.08.007. Epub 2015 Oct 21.
Assessments used to measure outcomes associated with rotator cuff pathology and after repair are varied. This lack of standardization leads to difficulty drawing comparisons across studies. We hypothesize that this variability in patient-reported outcome measures and objective metrics used in rotator cuff studies persists even in high-impact, peer reviewed journals.
All studies assessing rotator cuff tear and repair outcomes in 6 orthopedic journals with a high impact factor from January 2010 to December 2014 were reviewed. Cadaveric and animal studies and those without outcomes were excluded. Outcome measures included range of motion (forward elevation, abduction, external rotation, and internal rotation), strength (in the same 4 planes), tendon integrity imaging, patient satisfaction, and functional assessment scores.
Of the 156 included studies, 63% documented range of motion measurements, with 18% reporting range of motion in all 4 planes. Only 38% of studies reported quantitative strength measurements. In 65% of studies, tendon integrity was documented with imaging (38% magnetic resonance imaging/magnetic resonance anrhrogram, 31% ultrasound, and 8% computed tomography arthrogram). Finally, functional score reporting varied significantly, with the 5 most frequently reported scores ranging from 16% to 61% in studies, and 15 of the least reported outcomes were each reported in ≤6% of studies.
Significant variability exists in outcomes reporting after rotator cuff tear and repair, making comparisons between clinical studies difficult. Creating a uniformly accepted, validated outcomes tool that assesses pain, function, patient satisfaction, and anatomic integrity would enable consistent outcomes assessment after operative and nonoperative management and allow comparisons across the literature.
用于衡量与肩袖病变及其修复相关结果的评估方法多种多样。这种缺乏标准化的情况导致难以在各项研究之间进行比较。我们推测，即使在高影响力、经过同行评审的期刊中，肩袖研究中患者报告的结局指标和客观测量指标的这种变异性依然存在。
对2010年1月至2014年12月期间在6种高影响力的骨科期刊上发表的所有评估肩袖撕裂和修复结果的研究进行了综述。尸体研究、动物研究以及没有结果的研究均被排除。结局指标包括活动范围（前屈、外展、外旋和内旋）、力量（在相同的4个平面）、肌腱完整性成像、患者满意度和功能评估分数。
在纳入的156项研究中，63%记录了活动范围测量结果，其中18%报告了所有4个平面的活动范围。只有38%的研究报告了定量力量测量结果。在65%的研究中，通过成像记录了肌腱完整性（38%为磁共振成像/磁共振关节造影，31%为超声，8%为计算机断层扫描关节造影）。最后，功能评分报告差异显著，研究中最常报告的5种评分在16%至61%之间，而报告最少的15项结局在每项研究中的报告率均≤6%。
肩袖撕裂和修复后的结局报告存在显著变异性，这使得临床研究之间的比较变得困难。创建一个统一接受、经过验证的结局工具，用于评估疼痛、功能、患者满意度和解剖完整性，将能够在手术和非手术治疗后进行一致的结局评估，并允许在整个文献中进行比较。
