NYU Langone Health, New York, New York, U.S.A..
NYU Langone Health, New York, New York, U.S.A.
Arthroscopy. 2022 Jan;38(1):148-158.e6. doi: 10.1016/j.arthro.2021.05.050. Epub 2021 May 31.
The purpose of this study was to perform a network meta-analysis of the randomized controlled trials (RCTs) in the literature in order to assess the evidence defining the optimal combination of surgical technique single-row repair (SRR), double-row repair (DRR), or transosseous-equivalent/suture bridge (TOE/SB) arthroscopic rotator cuff repair (ARCR) and postoperative rehabilitation (early or late) protocol for ARCR.
The literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized SSR-early trials (RCTs) comparing SRR vs DRR vs TOE/SB ARCR techniques were included, as well as early vs late postoperative range of motion. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-score.
Twenty-eight studies comprising 2,181 total shoulders met the inclusion criteria. TOE/SB-late (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.08-0.46) and DRR-late (OR, 0.25; 95% CI, 0.12-0.52) were found to significantly reduce the rate of retear, with TOE/SB-late resulting in the highest P-score for the American Shoulder and Elbow Surgeons (P-score: 0.7911) score and retear rate (P-score: 0.8725). DRR-early did not result in any significant improvements over the SRR-early group, except in internal rotation. There was no significant difference in forward flexion between groups, with almost equivalent P-scores. Furthermore, TOE/SB-early and TOE/SB-late trended toward worsening external rotation compared with the control.
The current study suggests that rotator cuff repair using the TOE/SB technique and late postoperative mobilization yields the highest functional outcomes and lowest retear rate in the arthroscopic management of symptomatic rotator cuff tears.
Level I, meta-analysis of Level I studies.
本研究旨在对文献中的随机对照试验（RCT）进行网络荟萃分析，以评估定义关节镜肩袖修复术（ARCR）中手术技术单排修复（SRR）、双排修复（DRR）或经骨等效/缝线桥（TOE/SB）最佳组合以及术后康复（早期或晚期）方案的证据。
根据系统评价和荟萃分析的首选报告项目指南进行文献检索。纳入了比较 SRR 与 DRR 与 TOE/SB ARCR 技术的早期随机 SSR 试验（RCT），以及术后早期与晚期活动范围的比较。使用似然比网络荟萃分析的频率方法比较临床结果，使用 R 进行统计分析。使用 P 评分对治疗选择进行排名。
28 项研究共纳入 2181 个肩部符合纳入标准。TOE/SB-晚期（比值比[OR]，0.19；95%置信区间[CI]，0.08-0.46）和 DRR-晚期（OR，0.25；95% CI，0.12-0.52）被发现可显著降低再撕裂率，TOE/SB-晚期治疗的美国肩肘外科医生（ASES）评分和再撕裂率的 P 评分最高（P 评分：0.7911）。DRR-早期与 SRR-早期相比，除了内旋外，并没有显著改善。各组间前屈无显著差异，几乎具有相同的 P 评分。此外，与对照组相比，TOE/SB-早期和 TOE/SB-晚期的外旋趋势恶化。
本研究表明，在关节镜治疗症状性肩袖撕裂中，使用 TOE/SB 技术和晚期术后活动可获得最高的功能结果和最低的再撕裂率。
I 级，I 级研究的荟萃分析。
