Longo Umile Giuseppe, Lalli Alberto, Bandini Benedetta, Piccolomini Alice, Ullman Nathan S, Vaiano Andrea, D'Hooghe Pieter
Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy.
Knee Surg Sports Traumatol Arthrosc. 2025 Jun;33(6):2255-2268. doi: 10.1002/ksa.12651. Epub 2025 Apr 1.
The purpose of this systematic review was to assess the rate of progression to reverse total shoulder arthroplasty (RTSA) and to other interventions as revision surgeries after an arthroscopic repair of a massive rotator cuff tear (MRCT). Additionally, the review aimed at defining the best arthroscopic approach for the treatment of MRCTs in terms of failure and revision rates.
The purpose of this systematic review and meta-analysis was to evaluate the rates of progression to reverse total shoulder arthroplasty in patients who underwent primary arthroscopic repair of an MRCT with different arthroscopic procedures. A meta-analysis was performed to compare the rate of progression to revision surgery and reverse total shoulder arthroplasty.
Eighteen articles were included in the qualitative synthesis and 14 articles were included in the meta-analysis. Overall, 934 patients and 950 shoulders were involved in the review. Seven-hundred and thirty patients and 735 shoulders were included in the meta-analysis. The proportion of revisions to reverse total shoulder arthroplasty was 0.9%, 3.3% and 0.1% for complete repair, partial repair and superior capsular reconstruction, respectively. No statistically significant differences were found across the groups in terms of progression to reverse total shoulder arthroplasty (n.s.). The average proportions of revisions to interventions different than reverse total shoulder arthroplasty. were 0.9% for complete repair, 2.0% for partial repair and 2.0% for superior capsular reconstruction again, no statistically relevant difference was found among the groups (n.s.).
The current review finds no statistically significant differences in the progression to reverse total shoulder arthroplasty or other revision procedures among partial repair, complete repair and superior capsular reconstruction for massive irreparable rotator cuff tears. It is crucial to understand the long-term outcomes of different surgical techniques for massive rotator cuff tears, particularly regarding failure rates and progression to further procedures.
Level IV.
本系统评价旨在评估在巨大肩袖撕裂（MRCT）关节镜修复术后进展为反式全肩关节置换术（RTSA）以及进展为其他作为翻修手术的干预措施的发生率。此外，本评价旨在根据失败率和翻修率确定治疗MRCT的最佳关节镜入路。
本系统评价和荟萃分析的目的是评估接受不同关节镜手术进行MRCT初次关节镜修复的患者进展为反式全肩关节置换术的发生率。进行荟萃分析以比较进展为翻修手术和反式全肩关节置换术的发生率。
定性综合分析纳入了18篇文章，荟萃分析纳入了14篇文章。总体而言，本评价涉及934例患者和950个肩部。荟萃分析纳入了730例患者和735个肩部。完全修复、部分修复和上盂唇重建进展为反式全肩关节置换术的翻修比例分别为0.9%、3.3%和0.1%。在进展为反式全肩关节置换术方面，各组之间未发现统计学显著差异（无统计学意义）。进展为不同于反式全肩关节置换术的干预措施的平均翻修比例：完全修复为0.9%，部分修复为2.0%，上盂唇重建为2.0%，各组之间同样未发现统计学显著差异（无统计学意义）。
本评价发现，对于巨大不可修复性肩袖撕裂，在部分修复、完全修复和上盂唇重建进展为反式全肩关节置换术或其他翻修手术方面，未发现统计学显著差异。了解不同手术技术治疗巨大肩袖撕裂的长期结局至关重要，尤其是关于失败率和进展为进一步手术的情况。
四级
