Abstract
BackgroundRotator cuff tear is one of the most common complaint with shoulder pain, disability, or dysfunction. So far, different arthroscopic techniques including single row (SR), double row (DR), modified Mason–Allen (MMA), suture bridge (SB) and transosseous (TO) have been identified to repair rotator cuff. However, no study has reported the comparative efficacy of these 5 suture configurations. The overall aim of this network meta-analysis was to analyze the clinical outcomes and healing rate with arthroscopy among SR, DR, MMA, SB and TO.MethodsA systematic literature was searched from PubMed, EBSCO-MEDLINE, Web of Science, google scholar and www.dayi100.com, and checked for the inclusion and exclusion standards. The network meta-analysis was conducted using Review Manager 5.3 and SATA 15.0 software.ResultsThirty-four studies were eligible for inclusion, including 15 randomized controlled trials, 17 retrospective and 2 prospective cohort studies, with total 3250 shoulders. Two individual reviewers evaluated the quality of the 34 studies, the score form 5 and 9 of 10 were attained according to the Newcastle–Ottawa Scale for the 17 retrospective and 2 prospective studies. There was no significant distinction for the Constant score among 5 groups in the 16 studies with 1381 shoulders. The treatment strategies were ranked as MMA, DR, SB, SR and TO. In ASES score, 14 studies included 1464 shoulders showed that no significant differences was showed among all 5 groups after surgery. Whereas the efficacy probability was TO, MMA, DR, SB and SR according to the cumulative ranking curve. The healing rate in 25 studies include 2023 shoulders was significant in both SR versus DR [risk ratio 0.45 with 95% credible interval (0.31, 0.65)], and SR versus SB [risk ratio 0.45 (95% credible interval 0.29, 0.69)], and no significant in the other comparison, the ranking probability was MMA, SB, DR, TO and SR.ConclusionBased on the clinical results, this network meta-analysis revealed that these 5 suture configurations shows no significant difference. Meanwhile, suture bridge may be the optimum treatment strategy which may improve the healing rate postoperatively, whereas the DR is a suboptimal option for arthroscopic rotator cuff repairs.
Highlights
Rotator cuff tear is a common problem that impairs the shoulder, and leads to the shoulder pain and poor function, along with insomnia [1]
Inclusion criteria The inclusion criteria included: (1) patients diagnosed with rotator cuff injury and repaired with arthroscopy; (2) the control group was any suture configurations of 5, they were compared between two groups respectively. (3) the studies included clinical functional outcomes and healing rate for all groups, with outcomes in accordance with Constant score system, the American shoulder or elbow surgeons score system (ASES). (4) clinical followup at least 6 months; (5) randomized controlled trial (RCT), prospective or retrospective cohort studies
This study showed the following: (1) there was no significant differences among the five suture configurations in term of Constant score, and the overall ranking was modified Mason–Allen (MMA), double row (DR), suture bridge (SB), single row (SR), and TO; (2) there was no significant difference in ASES score, and the overall ranking was TO, MMA, DR, SB, and SR. (3) SR leading to a lower healing rate than DR and SB, and the ranking for healing rate was MMA, SB, DR, TO, and SR
Summary
Rotator cuff tear is a common problem that impairs the shoulder, and leads to the shoulder pain and poor function, along with insomnia [1]. American Academy of Orthopaedic Surgeons reports that only 16% of rotator cuff tears had been managed and treated appropriately whereas 31% “may” have been appropriate, and 53% were “rarely appropriate” [5]. This situation was still a challenge for rotator cuff tear repair worldwide, with the need to promote functional recovery and increase the healing rate. Rotator cuff tear is one of the most common complaint with shoulder pain, disability, or dysfunction. The overall aim of this network meta-analysis was to analyze the clinical outcomes and healing rate with arthroscopy among SR, DR, MMA, SB and TO
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