UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.
Knee Surg Sports Traumatol Arthrosc. 2023 May;31(5):1883-1902. doi: 10.1007/s00167-022-07099-9. Epub 2022 Aug 16.
To compare various nonarthroplasty treatment options for massive, irreparable rotator cuff tears, including allograft bridging/augmentation, debridement, partial repair, superior capsule reconstruction (SCR), subacromial balloon spacer, and tendon transfer.
A comprehensive search was conducted through the PubMed, MEDLINE, and EMBASE databases for all articles pertaining to nonarthroplasty treatment options for irreparable rotator cuff tears. Inclusion criteria included manuscripts published between 2009 and 2020 with at least 1 year follow-up and Level I-IV evidence. Articles were separated into six groups: debridement, arthroscopic and open repair, allograft bridging/augmentation, SCR, subacromial balloon spacer, and tendon transfer. Data points included range of motion (external rotation, abduction, forward flexion, and internal rotation), visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, rate of revision surgery, and rate of conversion to arthroplasty.
A total of 83 studies and 3363 patients were included. All treatment options had statistically significant improvements in postoperative range of motion and patient-reported outcomes. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. The SCR subgroup had the greatest improvement in ASES scores postoperatively. The overall revision rate was 7.2% among all surgical options, with the allograft bridging/augmentation group having the lowest rate of revision at 0-8.3%. The overall rate of conversion to arthroplasty was 7.2%, with debridement having the greatest rate of conversion at 15.4%.
All six nonarthroplasty treatment options for irreparable rotator cuff tears resulted in statistically significant improvements in range of motion and patient-reported outcomes at 1 year follow-up or more, with low rates of revision and conversion to arthroplasty. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. However, these conclusions should be interpreted with caution due to the heterogeneous nature of the data, lack of prospective randomized control trials, and short-term follow-up. The findings of this study highlight the complexity of irreparable, massive rotator cuff tears, and the need for an individualized approach when treating these patients.
Level IV.
比较各种非关节置换治疗方法治疗巨大、不可修复的肩袖撕裂，包括同种异体桥接/增强、清创、部分修复、上囊重建（SCR）、肩峰下气囊扩张器和肌腱转移。
通过 PubMed、MEDLINE 和 EMBASE 数据库全面检索 2009 年至 2020 年间关于不可修复肩袖撕裂的非关节置换治疗方法的所有文章。纳入标准包括至少 1 年随访的发表于 2009 年至 2020 年的 I-IV 级证据的手稿。文章分为 6 组：清创、关节镜和开放修复、同种异体桥接/增强、SCR、肩峰下气囊扩张器和肌腱转移。数据点包括运动范围（外旋、外展、前屈和内旋）、视觉模拟量表（VAS）疼痛评分、美国肩肘外科医师协会（ASES）评分、常数评分、翻修手术率和关节置换转换率。
共纳入 83 项研究和 3363 例患者。所有治疗方法在术后运动范围和患者报告的结果方面均有统计学显著改善。与其他治疗方法相比，清创术后外展和前屈运动范围有统计学显著改善，VAS 疼痛评分也更好。SCR 亚组术后 ASES 评分改善最大。所有手术选择的总体翻修率为 7.2%，同种异体桥接/增强组的翻修率最低为 0-8.3%。总体关节置换转化率为 7.2%，其中清创术转化率最高，为 15.4%。
不可修复肩袖撕裂的六种非关节置换治疗方法在 1 年及以上的随访中均使运动范围和患者报告的结果有统计学显著改善，且翻修率和关节置换转化率较低。与其他治疗方法相比，清创术后外展和前屈运动范围有统计学显著改善，VAS 疼痛评分也更好。然而，由于数据的异质性、缺乏前瞻性随机对照试验以及短期随访，这些结论应谨慎解释。本研究的结果强调了不可修复的巨大肩袖撕裂的复杂性，以及在治疗这些患者时需要个体化的方法。
IV 级。
