Le Breton Stephen, Forlizzi Julianne, Bono Olivia, MacAskill Meghan, Mousad Albert, Kush Sophie, O'Brien Makenzie, Christensen Alaia, Mithoefer Kai, Ramappa Arun, Ross Glen, Shah Sarav S
New England Baptist Hospital, Boston, Massachusetts, USA.
Tufts University School of Medicine, Boston, Massachusetts, USA.
Orthop J Sports Med. 2023 Mar 28;11(3):23259671221147896. doi: 10.1177/23259671221147896. eCollection 2023 Mar.
Recurrent tears of the rotator cuff pose a substantial problem despite advances in repair technique. Biologic augmentation via marrow stimulation or vented anchors may strengthen the suture-tendon junction and improve healing rates of native tissue, thereby enhancing outcomes of primary surgical repair.
To provide a focused systematic review and meta-analysis of local, intraoperative marrow-derived augmentation techniques in clinical primary rotator cuff repair.
Systematic review; Level of evidence, 4.
A systematic review of PubMed, Embase, and Cochrane was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 2131 studies from 2010 to 2022, focused on either marrow stimulation or vented anchors, were isolated and classified as either preclinical or clinical. Meta-analysis was performed for comparative marrow stimulation and vented anchor studies. Heterogeneity was tested through calculation of .
A total of 13 clinical studies were included in the review. All 9 comparative studies included in the meta-analysis demonstrated high methodologic quality or a low risk of bias. The pooled retear rate across all 9 clinical studies for patients undergoing marrow stimulation was 11%. For the 5 studies in the meta-analysis, the pooled retear rates were 15% for marrow stimulation and 30% for controls. Meta-analysis demonstrated a significant difference in the overall retear rate that favored marrow stimulation (odds ratio [OR], 0.41; 95% CI, 0.25-0.66; = .0003; = 0%). Similarly, meta-analysis of the Constant score at final follow-up demonstrated a statistically significant difference between the 2 groups that favored a higher Constant score in the marrow stimulation group (mean difference, 2.84; 95% CI, 1.02-4.66; = .002; = 29%). Vented anchors demonstrated improved ossification and bone density at the anchor site, but no difference in outcomes or retear. Pooled retear rates were 22.5% for vented anchors and 27.8% for controls.
Current evidence demonstrates that marrow-stimulation techniques may have a positive impact on healing and retear rate, while vented anchors have a muted impact relative to nonvented anchors. Although available evidence is limited and more research is needed, findings to date suggest that marrow stimulation techniques may be an inexpensive, straightforward technique to consider in qualifying patients to prevent rotator cuff retears.
尽管修复技术有所进步，但肩袖反复撕裂仍是一个重大问题。通过骨髓刺激或带孔锚钉进行生物增强可能会加强缝线-肌腱连接，并提高天然组织的愈合率，从而改善初次手术修复的效果。
对临床初次肩袖修复中局部术中骨髓来源的增强技术进行有针对性的系统评价和荟萃分析。
系统评价；证据等级，4级。
按照PRISMA（系统评价和荟萃分析的首选报告项目）指南，对PubMed、Embase和Cochrane进行系统评价。从2010年到2022年，共筛选出2131项研究，这些研究聚焦于骨髓刺激或带孔锚钉，并分为临床前研究或临床研究。对比较骨髓刺激和带孔锚钉的研究进行荟萃分析。通过计算I²检验异质性。
该评价共纳入13项临床研究。荟萃分析中纳入的所有9项比较研究方法学质量高或偏倚风险低。在所有9项临床研究中，接受骨髓刺激的患者的汇总再撕裂率为11%。在荟萃分析的5项研究中，骨髓刺激组的汇总再撕裂率为15%，对照组为30%。荟萃分析表明，总体再撕裂率存在显著差异，支持骨髓刺激（优势比[OR]，0.41；95%可信区间，0.25-0.66；P = 0.0003；I² = 0%）。同样，末次随访时Constant评分的荟萃分析表明，两组之间存在统计学显著差异，支持骨髓刺激组有更高的Constant评分（平均差异，2.84；95%可信区间，1.02-4.66；P = 0.002；I² = 29%）。带孔锚钉在锚钉部位的骨化和骨密度有所改善，但结果或再撕裂方面无差异。带孔锚钉的汇总再撕裂率为22.5%，对照组为27.8%。
目前的证据表明，骨髓刺激技术可能对愈合和再撕裂率有积极影响，而带孔锚钉相对于无孔锚钉的影响较小。尽管现有证据有限，还需要更多研究，但迄今为止的研究结果表明，骨髓刺激技术可能是一种廉价、直接的技术，可考虑用于符合条件的患者以预防肩袖再撕裂。
