Ono Yohei, Dávalos Herrera Diego Alejandro, Woodmass Jarret M, Boorman Richard S, Thornton Gail M, Lo Ian K Y
Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary; Calgary, Alberta, Canada.; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopedic Surgery, Colombia Universidad Nacional de Colombia Graduate School of Medicine, Bogota, Colombia.
Orthop J Sports Med. 2016 Dec 15;4(12):2325967116674191. doi: 10.1177/2325967116674191. eCollection 2016 Dec.
Arthroscopic repair of large to massive rotator cuff tears commonly retear. To improve healing rates, a number of different approaches have been utilized, including the use of grafts, which may enhance the biomechanical and biologic aspects of the repair construct. However, the outcomes after the use of grafts are diverse.
To systematically review the literature for large to massive rotator cuff tears to determine whether the use of grafts generally provides superior tendon healing and clinical outcomes to the repairs without grafts.
Systematic review; Level of evidence, 3.
A systematic review of the literature was performed. Clinical studies comparing the repairs with (graft group) and without grafts (control group) were included and analyzed. The primary outcome was tendon healing on either magnetic resonance imaging or ultrasound. The secondary outcome measures included visual analog scale for pain, University of California at Los Angles (UCLA) score, and forward elevation range. Differences between groups in all outcome measures were statistically analyzed.
Six comparative studies (level of evidence 2 or 3) with 13 study groups were included. A total of 242 repairs in the graft group (mean age, 62.5 ± 4.6 years) and 185 repairs in the control group (mean age, 62.5 ± 5.0 years) were analyzed. The graft types utilized included autograft (fascia lata) in 1 study, allograft (human dermis) in 2 studies, xenograft (bovine pericardium, porcine small intestine submucosa) in 2 studies, synthetic graft (polypropylene) in 1 study, and a combination of autograft (the long head of biceps) and synthetic graft (polypropylene) in 1 study. The overall mean follow-up time was 28.4 ± 9.0 months. When 1 or 2 studies/study groups were excluded due to practical or statistical reasons, the graft group demonstrated significantly improved healing (odds ratio, 2.48; 95% CI, 1.58-3.90; < .0001) and all clinical outcome measures at final follow-up ( ≤ .02).
The use of grafts generally provides superior tendon healing and clinical outcomes compared to repairs without grafts, except for some specific graft types (eg, porcine small intestine submucosa, bovine pericardium). Further investigations are required to determine the benefits of the use of grafts.
关节镜下修复大型至巨大型肩袖撕裂通常会再次撕裂。为提高愈合率，人们采用了多种不同方法，包括使用移植物，这可能会增强修复结构的生物力学和生物学特性。然而，使用移植物后的结果各不相同。
系统回顾关于大型至巨大型肩袖撕裂的文献，以确定使用移植物是否总体上比不使用移植物的修复方法能提供更好的肌腱愈合和临床结果。
系统回顾；证据等级，3级。
对文献进行系统回顾。纳入并分析比较使用移植物（移植物组）和不使用移植物（对照组）的修复方法的临床研究。主要结局是磁共振成像或超声检查显示的肌腱愈合情况。次要结局指标包括视觉模拟疼痛评分、加利福尼亚大学洛杉矶分校（UCLA）评分以及前屈范围。对所有结局指标在两组间的差异进行统计学分析。
纳入了6项比较研究（证据等级为2级或3级），共13个研究组。移植物组共分析了242例修复病例（平均年龄62.5±4.6岁），对照组共分析了185例修复病例（平均年龄62.5±5.0岁）。使用的移植物类型包括1项研究中的自体移植物（阔筋膜）、2项研究中的同种异体移植物（人真皮）、2项研究中的异种移植物（牛心包、猪小肠黏膜下层）、1项研究中的合成移植物（聚丙烯）以及1项研究中的自体移植物（肱二头肌长头）和合成移植物（聚丙烯）的组合。总体平均随访时间为28.4±9.0个月。由于实际或统计原因排除1或2项研究/研究组后，移植物组在最终随访时显示出显著改善愈合情况（优势比，2.48；95%可信区间，1.58 - 3.90；P <.0001）以及所有临床结局指标（P≤.02）。
与不使用移植物的修复方法相比，使用移植物总体上能提供更好的肌腱愈合和临床结果，但某些特定的移植物类型（如猪小肠黏膜下层、牛心包）除外。需要进一步研究以确定使用移植物的益处。
