Comparison of Multiple Surgical Treatments for Massive Irreparable Rotator Cuff Tears in Patients Younger Than 70 Years of Age: A Systematic Review and Network Meta-analysis.

Autor:	Bi AS; Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA., Anil U; Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA., Colasanti CA; Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA., Kwon YW; Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA., Virk MS; Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA., Zuckerman JD; Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA., Rokito AS; Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2024 Sep; Vol. 52 (11), pp. 2919-2930. Date of Electronic Publication: 2024 Jan 31.
DOI:	10.1177/03635465231204623
Abstrakt:	Background: Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis. Purpose: To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients <70 years of age for several patient-reported outcomes, range of motion (ROM), and acromiohumeral distance (AHD). Study Design: Network meta-analysis of comparative studies; Level of evidence, 3. Methods: A systematic review of the literature, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the MEDLINE, Embase, and Cochrane Library databases was conducted from 2017 to 2022. Inclusion criteria were (1) clinical comparative studies of MIRCTs (with several study-specific criteria); (2) ≥1 outcome of interest reported on, with standard deviations; (3) minimum 1-year follow-up; and (4) mean age of <70 years for both cohorts, without arthritis or pseudoparalysis. There were 8 treatment arms compared. Outcomes of interest were the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, visual analog scale for pain, AHD, and forward flexion and external rotation ROM. A frequentist approach to network meta-analysis with a random-effects model was performed using the netmeta package Version 0.9-6 in R. Results: A total of 23 studies met the inclusion criteria, with 1178 patients included in the network meta-analysis. There was a mean weighted age of 62.8 years, 568 (48.2%) men, with a mean follow-up of 28.9 months. There were no significant differences between groups in regard to sex ( P = .732) or age ( P = .469). For the ASES score, InSpace balloon arthroplasty (mean difference [MD], 12.34; 95% CI, 2.18 to 22.50; P = .017), arthroscopic bridging graft (aBG) (MD, 7.07; 95% CI, 0.28 to 13.85; P = .041), and long head of biceps augmented superior capsular reconstruction (BSCR) (MD, 5.16; 95% CI, 1.10 to 9.22; P = .013) resulted in the highest P-scores. For the Constant-Murley score, debridement (MD, 21.03; 95% CI, 8.98 to 33.08; P < .001) and aBG (MD, 6.97; 95% CI, 1.88 to 12.05; P = .007) resulted in the highest P-scores. For AHD, BSCR resulted in the highest P-score (MD, 1.46; 95% CI, 0.45 to 2.48; P = .005). For forward flexion ROM, debridement (MD, 45.77; 95% CI, 25.41 to 66.13; P < .001) resulted in the highest P-score, while RSA resulted in the lowest P-score (MD, -16.70; 95% CI, -31.20 to -2.20; P = .024). Conclusion: For patients <70 years with MIRCT without significant arthritis or pseudoparalysis, it appears that graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains, while RSA provides the least benefit in forward flexion. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Y.W.K. has received consulting fees from Orthopaedics and Flexion Therapeutics. M.S.V. has received consulting fees from Acumed and Exactech and support for education from Gotham Surgical Solutions & Devices. J.D.Z. has received consulting fees from Musculoskeletal Transplant Foundation and royalties from Exactech; he holds stock or stock options in AposTherapy; and he has received publishing royalties and financial or material support from SLACK Incorporated, Thieme Inc, and Wolters Kluwer Health–Lippincott Williams & Wilkins. A.S.R. has received support for education from Gotham Surgical Solutions & Devices and hospitality payments from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
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