Orellana Kevin J, Harwood Kathleen, Horneff John G, King Joseph J, Williams Brendan A
University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas.
Department of Orthopaedics, The Children's Hospital of Philadelphia.
J Pediatr Orthop B. 2023 Mar 1;32(2):103-109. doi: 10.1097/BPB.0000000000000990. Epub 2022 May 30.
Rotator cuff injuries (RCIs), traditionally thought to be an adult-type pathology, have been reported in the pediatric population, but there remains limited evidence regarding this injury pattern in pediatric patients. The purpose of this study was to systematically review the literature to characterize the epidemiology, injury patterns, treatment modalities, and outcomes for pediatric patients with RCIs. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, reviewing Pubmed, Embase, Cochrane, and CINAHL databases. Studies reporting imaging confirmed RCIs, and treatment outcomes in patients less than 18 years of age were included. Patient demographics, mechanism, injury type, and injury location were recorded. Treatment type and patient outcomes were abstracted when available and summarized with descriptive statistics. Our search identified 28 studies published from 1994 to 2020, which included 215 total tendons injured in 185 patients. Twenty-six studies were classified as level IV evidence, whereas only two were level III. When described, the most injured tendon ( n = 184) was the supraspinatus, whereas the most described injury type ( n = 215) was a partial tear. Surgical intervention was pursued in 75.8% of injuries, with arthroscopy being more common than open repair (79.4% vs. 20.6%). Nonoperative treatment was primarily utilized for partial tears. Among the 24 studies reporting on return to sports, nonoperatively managed patients returned later than those treated operatively (mean: 10.7 vs. 7 months). Only eight studies included patient reported outcome measures (PROMs), and just five had pre- and posttreatment scores. Three complications were noted, all in operative patients. RCIs in pediatric patients have been reported in the literature with increasing frequency over the last decade, but the quality of evidence remains poor with inconsistent injury descriptions and outcome reporting. Excellent results were seen for all injury types and locations with both operative and nonoperative treatments. The literature for pediatric RCIs remains limited in guiding management decisions indicating a need for more high-quality studies to compare outcomes across injury and treatment type. Level of evidence: level III.
传统上认为肩袖损伤（RCIs）是一种成人型病理状况，但儿科人群中也有相关报道，不过关于儿科患者这种损伤模式的证据仍然有限。本研究的目的是系统回顾文献，以描述儿科肩袖损伤患者的流行病学、损伤模式、治疗方式及治疗结果。按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统回顾，检索了PubMed、Embase、Cochrane和CINAHL数据库。纳入报告影像学确诊的肩袖损伤以及18岁以下患者治疗结果的研究。记录患者人口统计学信息、损伤机制、损伤类型和损伤部位。如有可用信息，提取治疗类型和患者治疗结果，并采用描述性统计进行总结。我们的检索确定了1994年至2020年发表的28项研究，共涉及185例患者的215条肌腱损伤。26项研究被归类为IV级证据，只有2项为III级。在有描述的情况下，损伤最多的肌腱（n = 184）是冈上肌，而描述最多的损伤类型（n = 215）是部分撕裂。75.8%的损伤采用了手术干预，关节镜检查比开放修复更常见（79.4%对20.6%）。非手术治疗主要用于部分撕裂。在24项报告恢复运动情况的研究中，非手术治疗的患者比手术治疗的患者恢复运动的时间更晚（平均：10.7个月对7个月）。只有8项研究纳入了患者报告的结局指标（PROMs），只有5项有治疗前后的评分。记录到3例并发症，均发生在手术患者中。在过去十年中，儿科患者肩袖损伤在文献中的报道频率不断增加，但证据质量仍然很差，损伤描述和结局报告不一致。手术和非手术治疗对所有损伤类型和部位均取得了良好效果。儿科肩袖损伤的文献在指导管理决策方面仍然有限，这表明需要更多高质量的研究来比较不同损伤和治疗类型的结局。证据级别：III级。
