Arthroscopic Versus Mini-open Rotator Cuff Repair: A Randomized Trial and Meta-analysis
| Autor: | Martin Bouliane, Richard Holtby, Donald Glasgow, Darren S. Drosdowech, Jaydeep Moro, George S. Athwal, Marie-Eve LeBel, David M Sheps, Aleem Lalani, Robert Balyk, Ian Lo, Joy C. MacDermid, Robert Hollinshead, Joints Canada, Farhad Moola, Joseph W. Bergman, Helen Razmjou, Richard Boorman, Peter B. MacDonald, Jeffrey Bury, Nicholas G. H. Mohtadi, Robert Litchfield, Kenneth J. Faber, Dianne Bryant, Ryan T. Bicknell, Robert G. McCormack |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Physical Therapy Sports Therapy and Rehabilitation Rotator Cuff Injuries law.invention Arthroscopy Rotator Cuff 03 medical and health sciences 0302 clinical medicine Meta-Analysis as Topic Randomized controlled trial law Humans Medicine Orthopedics and Sports Medicine Rotator cuff Range of Motion Articular Mini open 030222 orthopedics business.industry 030229 sport sciences 3. Good health Surgery Treatment Outcome medicine.anatomical_structure Meta-analysis Tears Female business |
| Zdroj: | The American Journal of Sports Medicine. 49:3184-3195 |
| ISSN: | 1552-3365 0363-5465 |
| DOI: | 10.1177/03635465211038233 |
| Popis: | Background: Patients with complete rotator cuff tears who fail a course of nonoperative therapy can benefit from surgical repair. Purpose: This randomized trial compared mini-open (MO) versus all-arthroscopic (AA) rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients with rotator cuff tears were randomized to undergo MO or AA repair at 9 centers by 23 surgeons. The primary outcome (Western Ontario Rotator Cuff Index [WORC]) and secondary outcomes (American Shoulder and Elbow Surgeons [ASES] score, Shoulder Pain and Disability Index [SPADI] pain subscale, 12-Item Short Form Health Survey [SF-12], reported medication use, adverse events), as well as measurements of range of motion and strength, were collected at 1 month before surgery; at 2 and 6 weeks postoperatively; and at 3, 6, 12, 18, and 24 months postoperatively. A blinded radiologist evaluated rotator cuff integrity on magnetic resonance imaging (MRI) at baseline and 1 year. Intention-to-treat analysis of covariance with the preoperative WORC score, age, and tear size as covariates assessed continuous outcomes. Sex differences were assessed. A meta-analysis synthesized the primary outcome between MO and AA repair with previous trials. Results: From 954 patients screened, 411 were ineligible (276 because of recovery with physical therapy), 449 were screened at surgery (175 ineligible), and 274 completed follow-up (138 MO and 136 AA). The AA and MO groups were similar before surgery. WORC scores improved from 40 preoperatively to 89 (AA) and 93 (MO) at 2 years, for an adjusted mean difference of 3.4 (95% CI, –0.4 to 7.2). There were no statistically significant differences between the AA and MO groups at any time point. All secondary patient-reported outcomes were not significantly different between the MO and AA groups, except the 2-year SPADI pain score (8 vs 12, respectively; P = .02). A similar recovery in range of motion and strength occurred in both groups over time. MRI indicated minimal improvement in muscle relative to fat (AA: n = 3; MO: n = 2), with most worsening (AA: n = 25; MO: n = 24) or remaining unchanged (AA: n = 70; MO: n = 70). Opioid use was significantly reduced after surgery (from 21% to 5%). The meta-analysis indicated no significant standardized mean difference between groups in the primary outcome across all pooled studies (standardized mean difference, –0.06 [95% CI, –0.34 to 0.22]). Conclusion: Both AA and MO rotator cuff repair provide large clinical benefits, with few adverse events. There is strong evidence of equivalent clinical improvements. Trial Registration: NCT00128076. |
| Databáze: | OpenAIRE |
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