Arthroscopic management of isolated partial-thickness rotator cuff tears.

Autor: Longo UG; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.; Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy., Marino M; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.; Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy., Lalli A; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.; Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy., Bandini B; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.; Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy., Giannarelli D; Department of Epidemiology and Biostatistics, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy., Ruiz Ibán MÁ; Hospital Universitario Ramon y Cajal, Madrid, Spain.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2024 Sep; Vol. 32 (9), pp. 2358-2375. Date of Electronic Publication: 2024 Jun 27.
DOI: 10.1002/ksa.12326
Abstrakt: Purpose: The aim of the present study is to provide a comprehensive review on the surgical outcomes following arthroscopic treatments of partial-thickness rotator cuff tears (PT-RCTs) and to compare the postoperative American Shoulder and Elbow Surgeons (ASES) score following in situ transtendon repair and tear completion, followed by repair.
Methods: Medline, EMBASE, Scopus, CINAHL and CENTRAL bibliographic databases were searched. Papers including patients with PT-RCTs of any grade who underwent treatment using debridement, in situ transtendon repair, tear completion and repair or bioinductive collagen implants were reviewed. Primary PT-RCTs were the sole indication for surgery. Primary postoperative outcomes assessed included the ASES score, the Absolute Constant-Murley score, the Simple Shoulder Test, the Visual Analogue Scale, the University of California-Los Angeles Shoulder Scale, the Western Ontario Rotator Cuff Score, range of motion, complications and revisions. A meta-analysis of comparative studies compared the postoperative ASES score between patients treated with in situ transtendon repair versus tear completion repair.
Results: Twenty-eight studies were included. The ASES score was reported by four comparative studies with contrasting results. The heterogeneity was high (I 2  = 86%), and effect sizes ranged from -0.49 in favour of the tear completion and repair technique to an effect size of +1.07 favouring in situ transtendon repair. The overall effect size of 0.02 suggests an equivalence between the two techniques in terms of the ASES score. Two studies with a total sample size of 111 patients reported on debridement, and four studies with a total sample size of 155 patients reported on bioinductive collagen implants.
Conclusion: Debridement alone is suitable for Ellman grades I-II PT-RCTs. In situ transtendon and tear completion repair techniques yield similar postoperative outcomes. Bioinductive collagen implants hold promise but lack long-term efficacy data. High-quality comparative studies are needed to determine the best treatment for PT-RCTs.
Level of Evidence: Level IV.
(© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)
Databáze: MEDLINE
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