Harley Jonathan D, Ray Lucas J, Olson Conner P, Comfort Spencer M, Harrison Alicia K, Saltzman Bryan M, Rao Allison J
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
JSES Int. 2025 Jan 16;9(3):691-697. doi: 10.1016/j.jseint.2024.12.009. eCollection 2025 May.
A systematic review and meta-analysis was conducted investigating sex-based differences in retear rate after arthroscopic rotator cuff repair (RCR). It is hypothesized that females experience a higher rate of retear than males.
We performed a systematic review of 3 databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they were written in English, published in a peer-reviewed journal, included patients with a history of arthroscopic RCR, reported failure rate based on sex, and had level of evidence 3 or higher. To assess failure, we used retear as our primary outcome, defined as a loss of structural integrity of the rotator cuff after primary repair, confirmed by imaging. Complications, reoperation, and patient-reported outcomes (PRO) were secondary outcomes.
In 11 eligible studies, there were 3134 patients, 1787 female (57%) and 1476 male (43%). Of 11 studies, 10 reported sex-specific rates of retear, 3 reported complications by sex, 3 reported reoperation by sex, and 2 reported PROs by sex. A random-effects model demonstrated no significant difference in retear rates between females and males (mean difference, .010 [95% CI, -.068 to .087]; = .81). Limited reporting prevented analysis for complication or reoperation rates. One study found significantly higher American Shoulder and Elbow Surgeons scores (92.2 vs. 88.2, = .002), Constant-Murley Score scores (92.2 vs. 81.8, < .001) and significantly lower visual analog scale pain scores (.75 vs. 1.39, < .001) for males compared with females. No other significant differences in PROs were found. A random-effects model showed a significant difference in age between patients with and without retear (mean difference, 4.38 years [95% CI, 1.81-6.95]; < .001).
Female and male patients showed no significant difference in retear rate following arthroscopic RCR. Retears were associated with increased age, which aligns with previous findings in the existing literature. Since many studies reported only one or a few of the desired outcomes, increasing the uniformity of outcome reporting related to RCR failure may be beneficial.
进行了一项系统评价和荟萃分析，以研究关节镜下肩袖修复术（RCR）后再撕裂率的性别差异。假设女性再撕裂率高于男性。
我们根据系统评价和荟萃分析的首选报告项目指南，对3个数据库进行了系统评价。纳入的研究需满足：以英文撰写、发表在同行评审期刊上、纳入有关节镜下RCR病史的患者、报告基于性别的失败率且证据等级为3级或更高。为评估失败情况，我们将再撕裂作为主要结局，定义为初次修复后肩袖结构完整性丧失，经影像学证实。并发症、再次手术和患者报告结局（PRO）为次要结局。
在11项符合条件的研究中，共有3134例患者，其中女性1787例（57%），男性1476例（43%）。在11项研究中，10项报告了性别特异性再撕裂率，3项报告了按性别分类的并发症，3项报告了按性别分类的再次手术，2项报告了按性别分类的PRO。随机效应模型显示，女性和男性的再撕裂率无显著差异（平均差异为0.010[95%CI，-0.068至0.087]；P = 0.81）。报告有限，无法分析并发症或再次手术率。一项研究发现，与女性相比，男性的美国肩肘外科医师评分显著更高（92.2对88.2，P = 0.002）、Constant-Murley评分显著更高（92.2对81.8，P < 0.001），视觉模拟量表疼痛评分显著更低（0.75对1.39，P < 0.001）。未发现PRO方面的其他显著差异。随机效应模型显示，有再撕裂和无再撕裂患者的年龄存在显著差异（平均差异为4.38岁[95%CI，1.81 - 6.95]；P < 0.001）。
关节镜下RCR术后，女性和男性患者的再撕裂率无显著差异。再撕裂与年龄增加有关，这与现有文献中的先前发现一致。由于许多研究仅报告了一个或几个期望的结局，提高与RCR失败相关的结局报告的一致性可能会有所帮助。
