Müller Andreas M, Flury Matthias, Alsayed Hasan N, Audigé Laurent
Research and Development, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.
Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2017 Jul;25(7):2089-2099. doi: 10.1007/s00167-017-4481-2. Epub 2017 Mar 2.
The purpose of this meta-analysis was to investigate patient and diagnostic parameters influencing the reported rates of recurrent rotator cuff defects after ARCR.
PubMed, EMBASE, Cochrane Library and Scopus databases were searched for clinical studies on tendon defects after ARCR. Imaging modalities, definitions, detection time points, and other known patient risk factors (patient age, tear severity, grade of fatty infiltration, repair technique) as well as reported defect rates were extracted. A meta-analysis of proportion and meta-regression analysis were used to investigate independent variables influencing reported defect rates.
Of 109 articles reviewed, the diagnostic studies used magnetic resonance imaging (MRI) only (n = 56), ultrasound (US) only (n = 28), MRI or computed tomography (CT) arthrography (CTA, n = 14) or a combination of US, MRI and CTA (n = 11) up to 57 months after ARCR. Definitions of tendon defects were highly variable, including those of partial tendon healing with insufficient thickness defined as either an acceptable outcome (n = 72) or a recurrent defect (n = 22). Reported defect rates demonstrated highly significant heterogeneity between studies and groups. Follow-up time and the evaluation of partial tendon healing were independent factors of the defect rate alongside age, tear severity and repair technique. The type of imaging did not significantly alter defect rates.
A number of specific factors significantly alter the rates of rotator cuff defects reported after ARCR. Standardized protocols in clinical practice are required for consistent diagnosis of recurrent defects after ARCR.
IV.
本荟萃分析旨在研究影响关节镜下修复肩袖后复发性肩袖缺损报告发生率的患者和诊断参数。
检索PubMed、EMBASE、Cochrane图书馆和Scopus数据库，查找有关关节镜下修复肩袖后肌腱缺损的临床研究。提取成像方式、定义、检测时间点以及其他已知的患者风险因素（患者年龄、撕裂严重程度、脂肪浸润等级、修复技术）以及报告的缺损率。采用比例荟萃分析和荟萃回归分析来研究影响报告缺损率的独立变量。
在审查的109篇文章中，诊断研究仅使用磁共振成像（MRI，n = 56）、仅使用超声（US，n = 28）、MRI或计算机断层扫描（CT）关节造影（CTA，n = 14）或在关节镜下修复肩袖后长达57个月使用US、MRI和CTA的组合（n = 11）。肌腱缺损的定义差异很大，包括部分肌腱愈合但厚度不足的定义，其被定义为可接受的结果（n = 72）或复发性缺损（n = 22）。报告的缺损率在研究和组之间显示出高度显著的异质性。随访时间和部分肌腱愈合的评估是缺损率的独立因素，同时还有年龄、撕裂严重程度和修复技术。成像类型并未显著改变缺损率。
一些特定因素会显著改变关节镜下修复肩袖后报告的肩袖缺损发生率。临床实践中需要标准化方案以一致诊断关节镜下修复肩袖后的复发性缺损。
IV级
