Fancher Andrew J, Mok Anthony C, Vopat Matthew L, Templeton Kim, Kimbrel Brandon K, Tarakemeh Armin, Mulcahey Mary K, Mullen Scott, Schroeppel John P, Vopat Bryan G
University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA.
University of Kansas School of Medicine-Kansas City, Kansas City, Kansas, USA.
Orthop J Sports Med. 2022 May 20;10(5):23259671221086259. doi: 10.1177/23259671221086259. eCollection 2022 May.
Rotator cuff repair (RCR) is a well-studied procedure. However, the impact of patient sex on outcomes after RCR has not been well studied.
To conduct a systematic review and meta-analysis of sex-based differences in outcomes after RCR and to record what proportion of studies examined this as a primary or secondary purpose.
Systematic review; Level of evidence, 4.
A systematic review was performed using multiple databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were written in English, performed on humans, consisted of patients who underwent RCR, evaluated at least 1 of the selected outcomes based on patient sex, and had statistical analysis available for their sex-based claim. Excluded were case reports, review studies, systematic reviews, cadaveric studies, and studies that did not report at least 1 sex-specific outcome or included certain other injuries associated with a rotator cuff injury.
Of 9998 studies screened and 1283 full-text studies reviewed, 11 (0.11%) studies with 2860 patients (1549 male and 1329 female) were included for quantitative analysis. None of these 11 studies examined the impact of patient sex on outcomes after RCR as a primary outcome. Postoperative Constant-Murley scores were analyzed for 7 studies. Male patients had a postoperative Constant-Murley score of 76.77 ± 15.94, while female patients had a postoperative Constant-Murley score of 69.88 ± 17.02. The random-effects model showed that male patients had significantly higher scores than female patients, with a mean difference of 7.33 (95% CI, 5.21-9.46; < .0001). Analysis of retear rates in 5 studies indicated that there was no difference in the retear rate between sexes (odds ratio, 0.91 [95% CI, 0.49-1.67]).
Female patients had lower postoperative Constant-Murley scores compared with male patients, but there was no difference in the retear rate. However, these results were based on an analysis of only 11 studies. The paucity of studies examining the impact of sex suggests that more research is needed on the impact of patient sex on outcomes after RCR.
肩袖修复术（RCR）是一项经过充分研究的手术。然而，患者性别对RCR术后疗效的影响尚未得到充分研究。
对RCR术后基于性别的疗效差异进行系统评价和荟萃分析，并记录将此作为主要或次要目的的研究比例。
系统评价；证据等级，4级。
根据PRISMA（系统评价和荟萃分析的首选报告项目）指南，使用多个数据库进行系统评价。纳入标准为：研究报告为英文、研究对象为人类、研究对象为接受RCR的患者、基于患者性别评估至少1项选定的结局指标，且有基于性别的统计分析数据。排除标准为：病例报告、综述研究、系统评价、尸体研究，以及未报告至少1项性别特异性结局指标或纳入了与肩袖损伤相关的某些其他损伤的研究。
在筛选的9998项研究和审阅的1283篇全文研究中，纳入11项研究（0.11%），共2860例患者（男性1549例，女性1329例）进行定量分析。这11项研究中无一将患者性别对RCR术后疗效的影响作为主要结局指标进行研究。对7项研究的术后Constant-Murley评分进行了分析。男性患者术后Constant-Murley评分为76.77±15.94，而女性患者术后Constant-Murley评分为69.88±17.02。随机效应模型显示，男性患者的评分显著高于女性患者，平均差值为7.33（95%CI，5.21-9.46；P<.0001）。对5项研究的再撕裂率分析表明，两性之间的再撕裂率没有差异（优势比，0.91[95%CI，0.49-1.67]）。
与男性患者相比，女性患者术后Constant-Murley评分较低，但再撕裂率没有差异。然而，这些结果仅基于对11项研究的分析。研究性别影响的研究较少，这表明需要更多关于患者性别对RCR术后疗效影响的研究。
