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Double-Row Repair With Platelet-Rich Plasma Optimizes Retear Rates After Small to Medium Full-Thickness Rotator Cuff Repair: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.
Lavoie-Gagne, Ophelie; Fury, Matthew S; Mehta, Nabil; Harkin, William E; Bernstein, David N; Berlinberg, Elyse J; Parvaresh, Kevin; O'Donnell, Evan; Forsythe, Brian.
Afiliación
  • Lavoie-Gagne O; Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, U.S.A.
  • Fury MS; Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, U.S.A.
  • Mehta N; Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Harkin WE; Rush University Medical Center, Chicago, Illinois, U.S.A.
  • Bernstein DN; Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, U.S.A.
  • Berlinberg EJ; Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A.
  • Parvaresh K; Orthopaedic Specialty Institute, Orange, California, U.S.A.
  • O'Donnell E; Massachusetts General Hospital, Boston, Massachusetts, U.S.A.
  • Forsythe B; Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A.. Electronic address: brian.forsythe@rushortho.com.
Arthroscopy ; 38(9): 2714-2729, 2022 09.
Article en En | MEDLINE | ID: mdl-35337958
ABSTRACT

PURPOSE:

To compare the different interventions described in the literature for the surgical treatment of small and medium complete rotator cuff tears.

METHODS:

A systematic review of randomized controlled trials of small-medium, full-thickness rotator cuff tears published since 2000 was performed. Clinical characteristics, re-tear rates, range of motion (ROM), and patient-reported outcomes (PRO) data were collected. Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects model. Interventions were ranked for each domain (re-tear risk, pain, ROM, and PROs) via surface under the cumulative ranking curves.

RESULTS:

A total of 18 studies comprising 2046 shoulders (47% females, mean age 61 ± 3 years, mean follow-up 21 ± 5 months) were included. Interventions that ranked highest for minimizing re-tear risk included arthroscopic single-row repair (A+SR) or double-row repair (A+DR) with or without platelet-rich plasma (PRP). Open repair and A+SR repair with acromioplasty (ACP) ranked highest for pain relief. Interventions that ranked highest for ROM improvement included open repair, PT, and A+DR with or without ACP. Interventions that ranked highest for PROs included arthroscopic footprint microfracture with or without SR, open repair, and A+SR with or without ACP.

CONCLUSIONS:

Based on a network meta-analysis of level 1 studies, arthroscopic rotator cuff repair with a SR or DR construct demonstrates similar retear rates, PROs, and clinical outcomes. The highest-ranking treatment for minimizing retears was arthroscopic repair with DR constructs and PRP augmentation, although open repair and arthroscopic SR remain reliable options with excellent clinical outcomes. Addition of PRP to DR constructs trended toward a 56% decreased risk of retear as compared to DR repair alone. Although no single treatment emerged superior, several interventions offered excellent clinical improvements in pain, ROM, and PROs that exceeded minimal clinically important difference thresholds. LEVEL OF EVIDENCE I, systematic review and meta-analysis of level I studies.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Plasma Rico en Plaquetas / Lesiones del Manguito de los Rotadores Tipo de estudio: Clinical_trials / Prognostic_studies / Systematic_reviews Aspecto: Patient_preference Límite: Female / Humans / Male / Middle aged Idioma: En Revista: Arthroscopy Asunto de la revista: ORTOPEDIA Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Plasma Rico en Plaquetas / Lesiones del Manguito de los Rotadores Tipo de estudio: Clinical_trials / Prognostic_studies / Systematic_reviews Aspecto: Patient_preference Límite: Female / Humans / Male / Middle aged Idioma: En Revista: Arthroscopy Asunto de la revista: ORTOPEDIA Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos
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