Descamps Jules, Kierszbaum Elliott, Protais Marie, Marion Blandine, Bouché Pierre-Alban, Aïm Florence
Hôpital Lariboisière, APHP, Paris 75010, France.
Clinique Blomet Paris Ramsay, 75015 Paris, France.
J Clin Med. 2023 Mar 29;12(7):2565. doi: 10.3390/jcm12072565.
Irreparable large to massive rotator cuff tears (MIRCTs) are a prevalent cause of shoulder pain and dysfunction, and nonoperative treatment may not always be effective. Various surgical options exist, with isolated biceps tenotomy/tenodesis (BT) or arthroscopic partial repair with associated biceps tenotomy/tenodesis (PCR-BT) being the most common. The aim of this study was to systematically review the available data on the clinical and functional outcomes of BT and PCR-BT in patients with MIRCTs.
MEDLINE, Embase, and CENTRAL databases were searched for studies on the treatment of MIRCT. We included studies with BT or PCR-BT with a minimum follow-up of 24 months. The MINORS (Methodological Index for Nonrandomized Studies) score was used to assess study quality. Outcomes included were the visual analog scale for pain, functional scores such as Constant-Murley and American Shoulder and Elbow Surgeons, range of motion, radiological measurements, and complications.
A total of 1101 patients (506 had a BT and 595 had a PCR-BT) from 22 studies were included (cases series = 13, case-control = 7, randomized control trial = 1, prospective cohort study = 1). The mean MINORS score was 13.2 ± 3.2. The mean age and follow-up were 67 ± 6.8 years and 4.58 ± 1.1 years (range, 2, 12), respectively. The VAS improvement showed at the last follow-up for PCR-BT (range, 1.97, 5.8) and BT (range, 4, 6.1). CMS was improved at the final follow-up for PCR-BT (range, 13, 47.6) and BT (range, 10.8, 28). Regarding the ASES, it has demonstrated significant improvements for PCR-BT (range, 31.81, 44.8) and BT (range, 30,45.8). For forward flexion, PCR-BT showed improvement (range, -14°, 59.4°), as well as the BT group (range, 2°, 27.9°).
This systematic review demonstrated that both BT and PCR-BT improve functional outcomes and reduce pain at midterm follow-up for MIRCT. Since we know that a failed cuff repair would worsen the shoulder, it might be beneficial in terms of the risk-benefit ratio to not repair in certain patients with MIRCT.
不可修复的大面积至巨大肩袖撕裂（MIRCTs）是肩部疼痛和功能障碍的常见原因，非手术治疗可能并非总是有效。存在多种手术选择，其中单纯肱二头肌切断术/腱固定术（BT）或关节镜下部分修复联合肱二头肌切断术/腱固定术（PCR - BT）最为常见。本研究的目的是系统回顾关于BT和PCR - BT治疗MIRCT患者的临床和功能结局的现有数据。
检索MEDLINE、Embase和CENTRAL数据库中关于MIRCT治疗的研究。我们纳入了随访至少24个月的BT或PCR - BT研究。使用MINORS（非随机研究方法学指数）评分评估研究质量。纳入的结局指标包括疼痛视觉模拟量表、功能评分如Constant - Murley评分和美国肩肘外科医师学会评分、活动范围、影像学测量以及并发症。
共纳入22项研究中的1101例患者（506例行BT，595例行PCR - BT）（病例系列 = 13项，病例对照 = 7项，随机对照试验 = 1项，前瞻性队列研究 = 1项）。平均MINORS评分为13.2 ± 3.2。平均年龄和随访时间分别为67 ± 6.8岁和4.58 ± 1.1年（范围2至12年）。末次随访时，PCR - BT组（范围1.97至5.8）和BT组（范围4至6.1）的VAS改善情况。末次随访时，PCR - BT组（范围13至47.6）和BT组（范围10.8至28）的CMS得到改善。关于ASES评分，PCR - BT组（范围31.81至44.8）和BT组（范围30至45.8）均有显著改善。前屈方面，PCR - BT组（范围 - 14°至59.4°）和BT组（范围2°至27.9°）均有改善。
本系统评价表明，在中期随访时，BT和PCR - BT均可改善MIRCT患者的功能结局并减轻疼痛。鉴于我们知道肩袖修复失败会使肩部情况恶化，对于某些MIRCT患者，不进行修复在风险效益比方面可能是有益的。
