Department of Orthopaedics, The Third Xiangya Hospital of Central South University, 410013, Changsha, Hunan, China.
Department of Rehabilitation, The Third Xiangya Hospital of Central South University, 410013, Changsha, Hunan, China.
J Orthop Surg Res. 2024 Oct 14;19(1):650. doi: 10.1186/s13018-024-05129-5.
Treatment of rotator cuff diseases often involves various arthroscopic procedures but their combined effectiveness remains contentious, especially in complex cases.
We focused on patients with degenerative shoulder cuff diseases requiring arthroscopic rotator cuff repair. Searches covered multiple databases (Medline, Embase, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Clinical Answers) up to April 1, 2024. Bias risk was assessed using RevMan (v 5.4), and a network meta-analysis was conducted with netmeta (v 2.8).
From 16 studies, 1232 patients (average age, 56.2 years; balanced sex ratio) were included. Arthroscopic rotator cuff repair ranked highest in functional score networks, surpassing other interventions. Physiotherapy was superior for pain relief compared to arthroscopic procedures combined with platelet-rich plasma (mean, 2.5; 95% confidence interval, 4.48-0.52). Arthroscopic rotator cuff repair and subacromial decompression were significantly superior to arthroscopic rotator cuff repair and subacromial decompression combined with platelet-rich plasma (MD, 1.80; 95% CI, 3.39-0.21).
Moderate bias risks were noted in both networks due to blinding issues and methodological quality reporting. Arthroscopic rotator cuff repair is favored for improving shoulder function, while other procedures or intra-articular treatments offer no significant benefits. Regarding pain management, physiotherapy is preferred; however, more evidence is needed to support this recommendation and caution is advised.
Systematic review registration PROSPERO CRD42023450150.
治疗肩袖疾病通常涉及各种关节镜手术，但它们的综合效果仍存在争议，尤其是在复杂病例中。
我们关注需要关节镜肩袖修复的退行性肩袖疾病患者。检索涵盖了多个数据库（Medline、Embase、Web of Science、Cochrane 系统评价数据库、Cochrane 对照试验中心注册库和 Cochrane 临床答案），截至 2024 年 4 月 1 日。使用 RevMan（v 5.4）评估偏倚风险，并使用 netmeta（v 2.8）进行网络荟萃分析。
从 16 项研究中，纳入了 1232 名患者（平均年龄 56.2 岁；性别比例均衡）。关节镜肩袖修复在功能评分网络中排名最高，优于其他干预措施。与关节镜手术联合富血小板血浆相比，物理疗法在缓解疼痛方面更具优势（均值，2.5；95%置信区间，4.48-0.52）。关节镜肩袖修复和肩峰下减压明显优于关节镜肩袖修复和肩峰下减压联合富血小板血浆（MD，1.80；95%CI，3.39-0.21）。
由于存在盲法问题和方法学质量报告，两个网络均存在中度偏倚风险。关节镜肩袖修复有利于改善肩部功能，而其他手术或关节内治疗则没有明显益处。关于疼痛管理，物理疗法是首选；然而，需要更多的证据来支持这一建议，并建议谨慎使用。
系统评价注册 PROSPERO CRD42023450150。
