Paramasivam Meenakshi Sundaram Pirateb, Lee Wei Wen Bryan, Sayampanathan Andrew Arjun, Tan Hwee Chye Andrew
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
JSES Int. 2020 Dec 5;5(2):254-260. doi: 10.1016/j.jseint.2020.10.007. eCollection 2021 Mar.
The ideal rotator cuff repair technique should allow for a quick and simple arthroscopic application which provides both adequate biomechanical stability and an appropriate biological state with the intention of promoting eventual healing of tendon to bone. While the biomechanical superiority of double-row repairs including higher repair strength, reduced gap formation, and wider footprint restoration have been proven, controversy remains regarding the clinical benefits of knotless compared with knot tying techniques. Our study aims to review the available evidence in the literature comparing the clinical outcomes between knotted and knotless transosseous double-row rotator cuff repair techniques.
A systematic literature search via PubMed, Embase, and Scopus was conducted by 2 independent reviewers. Studies reporting clinical outcomes of arthroscopic rotator cuff repair using the double-row knotted and knotless surgical techniques were identified. Data were analyzed with Review Manager 5.3, using Mantel-Haenszel statistics with both fixed and random effect models.
A total of 1144 studies were identified from our initial search. Based on our inclusion and exclusion criteria, 8 studies were eventually selected for our review. The selected studies were published between 2012 and 2018. Of the 8 studies, 3 reported level 2 evidence and 5 reported level 3 evidence. There were a total of 589 subjects. Our meta-analysis revealed that there were no significant differences in functional outcomes postoperatively when comparing Constant score (mean difference = -1.85, 95% confidence interval: -4.42 to 0.73), University of California at Los Angeles score (mean differences = -0.14, 95% confidence interval: -0.90 to 0.62), and American Shoulder and Elbow Surgeons score (mean differences = -2.19, 95% confidence interval: -5.55 to 1.17) between patients who underwent knotted and knotless rotator cuff repairs.
Our review revealed no statistically significant difference in functional outcomes between knotted and knotless transosseous double-row techniques for arthroscopic rotator cuff repairs. To our knowledge, this is the first meta-analysis related to this topic. However, no level 1 studies were available for this review. Further studies related to this topic should focus on reporting level 1 evidence comparing the clinical outcomes of knotless and knotted techniques for double-row repairs.
理想的肩袖修复技术应能在关节镜下快速简便地应用，既能提供足够的生物力学稳定性，又能营造适宜的生物学状态，以促进肌腱与骨的最终愈合。虽然双排修复在生物力学上具有优势，包括更高的修复强度、减少间隙形成以及更广泛的足迹恢复，但与打结技术相比，无结技术的临床益处仍存在争议。我们的研究旨在回顾文献中的现有证据，比较经骨双排肩袖修复技术中打结与无结技术的临床结果。
由两名独立 reviewers 通过 PubMed、Embase 和 Scopus 进行系统的文献检索。确定报告使用双排打结和无结手术技术进行关节镜肩袖修复临床结果的研究。使用 Review Manager 5.3 进行数据分析，采用 Mantel-Haenszel 统计方法，使用固定效应模型和随机效应模型。
我们的初步检索共识别出 1144 项研究。根据我们的纳入和排除标准，最终选择 8 项研究进行综述。所选研究发表于 2012 年至 2018 年之间。在这 8 项研究中，3 项报告了 2 级证据，5 项报告了 3 级证据。共有 589 名受试者。我们的荟萃分析显示，比较接受打结和无结肩袖修复患者的 Constant 评分（平均差异=-1.85，95%置信区间：-4.42 至 0.73）、加州大学洛杉矶分校评分（平均差异=-0.14，95%置信区间：-0.9至 0.62）和美国肩肘外科医生评分（平均差异=-2.19，95%置信区间：-5.55 至 1.17）时，术后功能结果无显著差异。
我们的综述显示，在关节镜肩袖修复的经骨双排技术中，打结与无结技术在功能结果上无统计学显著差异。据我们所知，这是关于该主题的首次荟萃分析。然而，本综述没有 1 级研究。与该主题相关的进一步研究应侧重于报告 1 级证据，比较无结和打结技术用于双排修复的临床结果。
