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Arthroscopic Versus Mini-open Rotator Cuff Repair: A Randomized Trial and Meta-analysis.
MacDermid, Joy C; Bryant, Dianne; Holtby, Richard; Razmjou, Helen; Faber, Kenneth; Balyk, Robert; Boorman, Richard; Sheps, David; McCormack, Robert; Athwal, George; Hollinshead, Robert; Lo, Ian; Bicknell, Ryan; Mohtadi, Nicholas; Bouliane, Martin; Glasgow, Donald; Lebel, Marie-Eve; Lalani, Aleem; Moola, Farhad O; Litchfield, Robert; Moro, Jaydeep; MacDonald, Peter; Bergman, J W; Bury, Jeff; Drosdowech, Darren.
Afiliación
  • MacDermid JC; Departments of Surgery and Physical Therapy, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.
  • Bryant D; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Holtby R; Departments of Surgery and Physical Therapy, University of Western Ontario, London, Ontario, Canada.
  • Razmjou H; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Faber K; Department of Orthopaedic Surgery, Holland Orthopaedic & Arthritic Centre, Toronto, Ontario, Canada.
  • Balyk R; Department of Rehabilitation, Holland Orthopaedic & Arthritis Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.
  • Boorman R; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Sheps D; Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.
  • McCormack R; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Athwal G; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Hollinshead R; Department of Surgery and Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.
  • Lo I; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Bicknell R; Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
  • Mohtadi N; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Bouliane M; Department of Surgery and Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.
  • Glasgow D; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Lebel ME; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
  • Lalani A; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Moola FO; Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.
  • Litchfield R; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Moro J; Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
  • MacDonald P; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Bergman JW; Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
  • Bury J; Investigation performed at the University of Western Ontario, London, Ontario, Canada.
  • Drosdowech D; Department of Surgery, Queen's University, Kingston, Ontario, Canada.
Am J Sports Med ; 49(12): 3184-3195, 2021 10.
Article en En | MEDLINE | ID: mdl-34524031
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Manguito de los Rotadores / Lesiones del Manguito de los Rotadores Tipo de estudio: Clinical_trials / Systematic_reviews Aspecto: Patient_preference Límite: Female / Humans / Male Idioma: En Revista: Am J Sports Med Año: 2021 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Manguito de los Rotadores / Lesiones del Manguito de los Rotadores Tipo de estudio: Clinical_trials / Systematic_reviews Aspecto: Patient_preference Límite: Female / Humans / Male Idioma: En Revista: Am J Sports Med Año: 2021 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos