Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Shoulder Elbow Surg. 2024 Sep;33(9):e465-e477. doi: 10.1016/j.jse.2024.03.014. Epub 2024 Apr 19.
To identify and quantify the factors associated with the reparability of rotator cuff tears (RCTs).
PubMed, Scopus, and Web of Science databases were searched for clinical studies published in English focusing on RCT reparability by using the keywords "rotator cuff tear" and "reparability". A meta-analysis was conducted if ≥3 studies examined the same factor and provided enough data to assess RCT reparability. Quality assessment was completed using the quality assessment of diagnostic accuracy studies tool.
Eighteen studies (2700 patients) were enrolled and 26 factors were included in the meta-analysis. The dichotomous variables associated with irreparability were Patte stage 3 (odds ratio (OR): 8.0, 95% confidence interval [CI]: 4.3-14.9), massive tear vs. large tear (OR: 3.1, 95% CI: 1.3-7.2), Goutallier stage for each tendon, and tangent sign (OR: 11.1, 95% CI: 4.3-28.4). The continuous variables associated with irreparability were age (mean difference (MD): 3.25, 95% CI: 1.4-5.1), mediolateral tear size (MD: 12.3, 95% CI: 5.8-18.9), anteroposterior tear size (MD: 10.4, 95% CI: 5.2-15.6), acromiohumeral distance on X-ray (MD: -2.3, 95% CI: -3.0 to -1.6) and magnetic resonance imaging (MD: -1.8, 95% CI: -2.8 to -0.9), and inferior glenohumeral distance on magnetic resonance imaging (MD: 2.2, 95% CI: 1.4-3.0).
This study revealed that older age, larger tear size, severe fatty infiltration, muscle atrophy, and advanced superior migration of the humeral head were strongly associated with irreparable RCTs. Conversely, clinical symptoms provided limited information for predicting reparability. Additionally, the tangent sign emerged as a powerful and simple tool for individual prediction, and several quantitative scoring systems also proved useful.
确定和量化与肩袖撕裂（RCT）修复能力相关的因素。
使用“rotator cuff tear”和“reparability”等关键词，在 PubMed、Scopus 和 Web of Science 数据库中搜索发表于英文的聚焦于 RCT 修复能力的临床研究，进行 meta 分析。如果≥3 项研究检查了相同的因素并提供了足够的数据来评估 RCT 的修复能力，则进行 meta 分析。使用诊断准确性研究工具的质量评估工具完成质量评估。
共纳入 18 项研究（2700 例患者），26 个因素纳入 meta 分析。与不可修复性相关的二分类变量为 Patte 3 期（比值比（OR）：8.0，95%置信区间[CI]：4.3-14.9）、巨大撕裂与大撕裂（OR：3.1，95% CI：1.3-7.2）、每个肌腱的 Goutallier 分期和切线征（OR：11.1，95% CI：4.3-28.4）。与不可修复性相关的连续变量为年龄（平均差异（MD）：3.25，95% CI：1.4-5.1）、中外侧撕裂大小（MD：12.3，95% CI：5.8-18.9）、前后撕裂大小（MD：10.4，95% CI：5.2-15.6）、X 线肩峰肱骨头间距（MD：-2.3，95% CI：-3.0 至-1.6）和磁共振成像（MD：-1.8，95% CI：-2.8 至-0.9），以及磁共振成像下下盂肱距离（MD：2.2，95% CI：1.4-3.0）。
本研究表明，年龄较大、撕裂较大、严重脂肪浸润、肌肉萎缩和肱骨头的高级别上移与不可修复的 RCT 密切相关。相比之下，临床症状提供的信息有限，无法预测修复能力。此外，切线征是一种强大而简单的个体预测工具，几种定量评分系统也被证明有用。
