Orthopedics and Traumatology Service, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.
Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Plataforma Invest-KER Unit Mexico, Monterrey, Mexico.
Arthroscopy. 2021 Jun;37(6):1937-1947.e1. doi: 10.1016/j.arthro.2020.12.191. Epub 2020 Dec 24.
To assess retear rates in arthroscopic double-row rotator cuff repair (double-row RCR) with and without platelet-rich therapy (PRT).
Systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, Embase, and Scopus databases were searched for RCTs involving use of PRT exclusively in arthroscopic double-row RCR. A random-effects model and the generic inverse variance method were used for quantitative data synthesis. Heterogeneity was tested with the I statistic index.
The 9 RCTs included in the meta-analysis demonstrated a risk reduction of 49% for retears in patients receiving PRT (risk ratio [RR] 0.51; 95% confidence interval [CI] 0.35 to 0.76; P = .0008; I = 0%). Divided by tear sizes, retear risk reduction of 47% (RR 0.53; 95% CI 0.30 to 0.95; P = .03; I = 0%) was found in small to medium tears and 51% (RR 0.49; 95% CI 0.29 to 0.84; P = .009; I = 0%) in large to massive tears. Linked double-row RCR resulted in risk reduction of 51% for retears in comparison with nonlinked repairs.
Double-row RCR plus PRT significantly reduced retear rates in all sizes of rotator cuff tears. Linked double-row RCR and applying the PRT during the surgical procedure and in the tendon-bone interface reproduced the best outcomes. Clinically, all patients improved, and no statistically significant difference was seen in clinical and functional scores between the intervention groups. All patients achieved optimal values for patient-reported outcomes measures.
I, systematic review and meta-analysis of level I studies.
评估关节镜下双排肩袖修复术（双排 RCR）中应用富血小板治疗（PRT）与不应用 PRT 的再撕裂率。
系统评价和随机对照试验（RCT）的荟萃分析。检索 MEDLINE、Embase 和 Scopus 数据库，纳入仅使用 PRT 治疗关节镜下双排 RCR 的 RCT。采用随机效应模型和通用倒数方差法进行定量数据合成。使用 I ² 统计量检验异质性。
荟萃分析纳入的 9 项 RCT 显示，接受 PRT 治疗的患者再撕裂风险降低了 49%（风险比 [RR] 0.51；95%置信区间 [CI] 0.35 至 0.76；P =.0008；I ² = 0%）。按撕裂大小分层，小至中等撕裂的再撕裂风险降低 47%（RR 0.53；95% CI 0.30 至 0.95；P =.03；I ² = 0%），大至巨大撕裂的再撕裂风险降低 51%（RR 0.49；95% CI 0.29 至 0.84；P =.009；I ² = 0%）。与非连接双排 RCR 相比，连接双排 RCR 可降低再撕裂风险 51%。
双排 RCR 联合 PRT 可显著降低各种大小肩袖撕裂的再撕裂率。连接双排 RCR 并在手术过程中和肌腱-骨界面应用 PRT 可获得最佳效果。临床方面，所有患者均得到改善，干预组之间的临床和功能评分无统计学差异。所有患者的患者报告结局测量值均达到最佳值。
I，基于 I 级研究的系统评价和荟萃分析。
