Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, U.S.A.
Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthroscopy. 2022 Sep;38(9):2714-2729. doi: 10.1016/j.arthro.2022.03.014. Epub 2022 Mar 22.
To compare the different interventions described in the literature for the surgical treatment of small and medium complete rotator cuff tears.
A systematic review of randomized controlled trials of small-medium, full-thickness rotator cuff tears published since 2000 was performed. Clinical characteristics, re-tear rates, range of motion (ROM), and patient-reported outcomes (PRO) data were collected. Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects model. Interventions were ranked for each domain (re-tear risk, pain, ROM, and PROs) via surface under the cumulative ranking curves.
A total of 18 studies comprising 2046 shoulders (47% females, mean age 61 ± 3 years, mean follow-up 21 ± 5 months) were included. Interventions that ranked highest for minimizing re-tear risk included arthroscopic single-row repair (A+SR) or double-row repair (A+DR) with or without platelet-rich plasma (PRP). Open repair and A+SR repair with acromioplasty (ACP) ranked highest for pain relief. Interventions that ranked highest for ROM improvement included open repair, PT, and A+DR with or without ACP. Interventions that ranked highest for PROs included arthroscopic footprint microfracture with or without SR, open repair, and A+SR with or without ACP.
Based on a network meta-analysis of level 1 studies, arthroscopic rotator cuff repair with a SR or DR construct demonstrates similar retear rates, PROs, and clinical outcomes. The highest-ranking treatment for minimizing retears was arthroscopic repair with DR constructs and PRP augmentation, although open repair and arthroscopic SR remain reliable options with excellent clinical outcomes. Addition of PRP to DR constructs trended toward a 56% decreased risk of retear as compared to DR repair alone. Although no single treatment emerged superior, several interventions offered excellent clinical improvements in pain, ROM, and PROs that exceeded minimal clinically important difference thresholds.
I, systematic review and meta-analysis of level I studies.
比较 2000 年后发表的文献中描述的治疗小、中全层肩袖撕裂的不同干预措施。
对 2000 年后发表的小-中全层肩袖撕裂的随机对照试验进行了系统评价。收集临床特征、再撕裂率、运动范围（ROM）和患者报告的结果（PRO）数据。通过基于臂的贝叶斯网络荟萃分析在随机效应模型中比较干预措施。通过累积排序曲线下的表面来对每个领域（再撕裂风险、疼痛、ROM 和 PRO）的干预措施进行排名。
共纳入 18 项研究，共 2046 例肩部（47%为女性，平均年龄 61±3 岁，平均随访 21±5 个月）。最小化再撕裂风险的干预措施包括关节镜下单排修复（A+SR）或双排修复（A+DR），可与富血小板血浆（PRP）联合使用。开放修复和 A+SR 联合肩峰成形术（ACP）的止痛效果最佳。ROM 改善效果最佳的干预措施包括开放修复、PT 和 A+DR，可与 ACP 联合使用。PRO 最佳的干预措施包括关节镜下骨-腱交接区微骨折术，可与 SR 联合使用，也可与 SR 联合使用。
基于对 1 级研究的网络荟萃分析，关节镜下肩袖修复术采用 SR 或 DR 重建，再撕裂率、PRO 和临床结果相似。最小化再撕裂的最佳治疗方法是使用 DR 构建物和 PRP 增强的关节镜修复，尽管开放修复和关节镜下 SR 仍然是可靠的选择，具有出色的临床效果。与单独使用 DR 修复相比，向 DR 构建物中添加 PRP 可使再撕裂的风险降低 56%。尽管没有一种治疗方法脱颖而出，但几种干预措施在疼痛、ROM 和 PRO 方面提供了出色的临床改善，超过了最小临床重要差异阈值。
I，1 级研究的系统评价和荟萃分析。
