Stojanov Thomas, Audigé Laurent, Modler Linda, Aghlmandi Soheila, Appenzeller-Herzog Christian, Loucas Rafael, Loucas Marios, Müller Andreas Marc
Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland.
Research and Development, Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland.
JSES Int. 2022 Sep 29;7(1):50-57. doi: 10.1016/j.jseint.2022.09.003. eCollection 2023 Jan.
The identification of factors that specify prognostic models for postoperative results should be based on the best scientific evidence and expert assessment. We aimed to identify, map, and evaluate potential prognostic factors for the improvement of shoulder function in patients undergoing arthroscopic rotator cuff repair.
Longitudinal primary studies of arthroscopic rotator cuff repair reporting any multivariable factor analyses for shoulder function improvement with an endpoint assessment of at least 6 months were included. We systematically searched EMBASE, Medline, and Scopus for articles published between January 2014 and June 2021. The risk of bias of included studies and the quality of evidence were assessed using the Quality in Prognosis Studies tool and an adapted Grading of Recommendations, Assessment, Development, and Evaluations framework.
Overall, 24 studies including 73 outcome analyses were included. We classified younger age and smaller tear size as probably prognostic for a greater improvement in objective outcomes. Shorter symptom duration, absence of a worker compensation claim, low preoperative level of functional status, and high preoperative pain level were classified as probably prognostic for greater improvement in patient-reported outcome measures. The quality of the synthesized evidence was low. Twenty-one studies had an overall high risk of bias.
Six potential prognostic factors for shoulder function after arthroscopic rotator cuff repair were identified. Along with ongoing expert opinion assessments, they will feed into a prognostic model-building process.
确定用于术后结果的预后模型的因素应基于最佳科学证据和专家评估。我们旨在识别、梳理并评估关节镜下肩袖修补术患者肩功能改善的潜在预后因素。
纳入关节镜下肩袖修补术的纵向原发性研究，这些研究报告了任何关于肩功能改善的多变量因素分析，且终点评估至少为6个月。我们系统检索了EMBASE、Medline和Scopus数据库，以查找2014年1月至2021年6月期间发表的文章。使用预后研究质量工具和改编后的推荐分级、评估、制定和评价框架评估纳入研究的偏倚风险和证据质量。
总体而言，纳入了24项研究，包括73项结果分析。我们将较年轻的年龄和较小的撕裂尺寸归类为可能对客观结果有更大改善的预后因素。症状持续时间较短、无工伤赔偿申请、术前功能状态水平较低以及术前疼痛水平较高被归类为可能对患者报告的结局指标有更大改善的预后因素。综合证据的质量较低。21项研究总体存在较高的偏倚风险。
确定了关节镜下肩袖修补术后肩功能的六个潜在预后因素。连同持续的专家意见评估，它们将纳入预后模型构建过程。
