Department of Medicine and Health Science "Vincenzo Tiberio," University of Molise, Campobasso, Italy; Faculty of Medicine, University "Tor Vergata", Rome, Italy.
Faculty of Medicine, University "Tor Vergata", Rome, Italy.
J Shoulder Elbow Surg. 2021 Nov;30(11):2648-2659. doi: 10.1016/j.jse.2021.04.040. Epub 2021 May 19.
Rotator cuff (RC) tears have been widely studied as many treatment strategies have been recommended. However, optimal management for patients with RC tears is still unclear.
The main aim of this systematic review was to analyze randomized controlled trials using meta-analysis to compare repair to conservative treatments for patients with any type of RC tear.
MEDLINE, Cochrane Library (CENTRAL database), PEDro, and Scopus databases were used. Two independent reviewers selected randomized controlled trials that compared surgical to conservative treatments for RC tear patients. The studies included were assessed using Cochrane Risk of Bias 2 tools, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the certainty of evidence and to summarize the study conclusions.
Six trials were included. Pooled results showed improvement in function and pain perception in favor of the repair group at 6 months (mean difference 1.26, 95% CI -2.34, 4.85, P = .49; and -0.59, 95% CI -0.84, -0.33, P < .001, respectively), at 12 months (mean difference 5.25, 95% CI 1.55, 8.95, P = .005, for function; and -0.41, 95% CI -0.70, -0.12, P = .006, for pain) and at 24 months (mean difference 5.57, 95% CI 1.86, 9.29, P = .003, for function; and -0.92, 95% CI -1.31, -0.52, P < .001, for pain) in RC tear patients. However, these differences did not reach the minimum clinically important difference. The certainty of evidence ranged from low to moderate because of imprecision in the studies included.
Overall analysis showed that in patients with RC tear, repair compared with conservative treatment could result in increased pain reduction and functional improvement at 6, 12, and 24 months. Even if these effects were often statistically significant, their clinical relevance was limited. Moreover, the certainty of body of evidence ranged from low to moderate.
肩袖撕裂（RC）已被广泛研究，因为已经推荐了许多治疗策略。然而，RC 撕裂患者的最佳治疗方法仍不清楚。
本系统评价的主要目的是通过荟萃分析分析随机对照试验，比较任何类型 RC 撕裂患者的修复与保守治疗。
使用 MEDLINE、Cochrane 图书馆（CENTRAL 数据库）、PEDro 和 Scopus 数据库。两名独立的评审员选择了比较 RC 撕裂患者手术与保守治疗的随机对照试验。使用 Cochrane 风险偏倚 2 工具评估纳入的研究，并使用推荐评估、制定与评估（GRADE）系统评估证据的确定性，并总结研究结论。
纳入了 6 项试验。汇总结果显示，修复组在 6 个月时在功能和疼痛感知方面的改善更为明显（平均差异 1.26，95%CI-2.34，4.85，P=.49；-0.59，95%CI-0.84，-0.33，P<.001），在 12 个月（功能平均差异 5.25，95%CI1.55，8.95，P=.005；疼痛平均差异-0.41，95%CI-0.70，-0.12，P=.006）和 24 个月（功能平均差异 5.57，95%CI1.86，9.29，P=.003；疼痛平均差异-0.92，95%CI-1.31，-0.52，P<.001）时，RC 撕裂患者的修复组优于保守组。然而，这些差异没有达到最小临床重要差异。由于纳入的研究存在不精确性，证据的确定性范围从低到中等。
总体分析表明，在 RC 撕裂患者中，与保守治疗相比，修复治疗可在 6、12 和 24 个月时增加疼痛减轻和功能改善。即使这些效果通常具有统计学意义，但它们的临床相关性有限。此外，证据的确定性范围从低到中等。
