Fairley Jillian A, Pollock J W, McIlquham Katie, Lapner Peter
Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
J Shoulder Elbow Surg. 2024 Jan;33(1):210-222. doi: 10.1016/j.jse.2023.08.012. Epub 2023 Sep 26.
There is ongoing controversy regarding the effect of bone channeling in arthroscopic rotator cuff repair. Since the most recent systematic reviews in 2019, several large high-level trials have been completed. This study assessed all available level I randomized controlled trials (RCTs) that compared arthroscopic rotator cuff repair with and without bone marrow channeling.
A systematic search of the Ovid MEDLINE, Embase, and Cochrane Library databases was conducted through mid January 2023. Two reviewers performed screening of studies meeting the eligibility criteria: English-language RCTs in patients aged ≥18 years comparing arthroscopic rotator cuff repair of full-thickness tears with and without bone marrow channeling (channeling group and control group, respectively). Functional scores, pain, healing rates, and reoperations were reviewed using pooled analysis where appropriate. The methodologic quality of included studies was assessed using the Cochrane risk-of-bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
A total of 6 randomized studies (N = 593) met the inclusion criteria. Pooled analysis of all 6 studies showed no significant mean difference in function (1.32; 95% confidence interval [CI], -0.63 to 3.26), as measured by the Constant-Murley score. Retear rates were also not statistically different between groups (risk ratio, 0.99; 95% CI, 0.57 to 1.71), with pooled retear rates of 19.6% (48 of 245) with channeling and 19.8% (51 of 257) without. The other outcomes of interest were only available for analysis in a subset of studies. There were no standardized mean differences in pain (0.09; 95% CI, -0.18 to 0.36), and there were similar reoperation rates (risk ratio, 1.19; 95% CI, 0.43 to 3.34) in the channeling and control groups. For the included studies, the overall quality of evidence by outcome was judged to be moderate (function, pain, and reoperations) or low (retear rates), mainly owing to risk of bias (all outcomes) and inconsistency (retear rates).
The results of this study refute the findings of prior systematic reviews that showed that channeling reduces the retear rate when combined with arthroscopic rotator cuff repair. This meta-analysis of level I evidence, including recent larger RCTs, demonstrates that bone marrow stimulation in the setting of primary arthroscopic rotator cuff repair has no significant effect on functional outcomes, healing, pain, or reoperation rates.
关于关节镜下肩袖修复术中骨隧道技术的效果，目前仍存在争议。自2019年最近的系统评价以来，已经完成了几项大型的高水平试验。本研究评估了所有可用的I级随机对照试验（RCT），这些试验比较了关节镜下肩袖修复术有无骨髓隧道技术的情况。
通过检索截至2023年1月中旬的Ovid MEDLINE、Embase和Cochrane图书馆数据库进行系统搜索。两名研究者对符合纳入标准的研究进行筛选：年龄≥18岁患者的英文RCT，比较全层撕裂的关节镜下肩袖修复术有无骨髓隧道技术（分别为隧道组和对照组）。在适当情况下，使用汇总分析对功能评分、疼痛、愈合率和再次手术情况进行评估。使用Cochrane偏倚风险工具和推荐分级评估、制定与评价（GRADE）方法评估纳入研究的方法学质量。
共有6项随机研究（N = 593）符合纳入标准。对所有6项研究的汇总分析显示，以Constant-Murley评分衡量，功能方面无显著平均差异（1.32；95%置信区间[CI]，-0.63至3.26）。两组间再撕裂率也无统计学差异（风险比，0.99；95%CI，0.57至1.71），隧道组的汇总再撕裂率为19.6%（245例中的48例），非隧道组为19.8%（257例中的51例）。其他感兴趣的结果仅在部分研究中可供分析。疼痛方面无标准化平均差异（0.09；95%CI，-0.18至0.36），隧道组和对照组的再次手术率相似（风险比，1.19；95%CI，0.43至3.34）。对于纳入研究，按结果判断的总体证据质量为中等（功能、疼痛和再次手术）或低（再撕裂率），主要是由于偏倚风险（所有结果）和不一致性（再撕裂率）。
本研究结果反驳了先前系统评价的结果，即先前研究表明隧道技术与关节镜下肩袖修复术联合应用可降低再撕裂率。这项对I级证据的荟萃分析，包括近期更大规模的RCT，表明在初次关节镜下肩袖修复术中进行骨髓刺激对功能结果、愈合、疼痛或再次手术率没有显著影响。
