Potential benefit of double-row repairs in rotator cuff tears greater than 3 cm .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(17):10 Arthroscopy. 2013 Aug;29(8):1437-496 randomized control trials, 4 prospective cohort studies and 2 retrospective cohort studies comparing functional and clinical effects of single- and double-row repairs of a torn rotator cuff were selected for inclusion in this meta-analysis and systematic review. The findings stated improved function, decreased pain and increased odds of healing in favour of double-row repairs; however the results were not clinically significant. Also, there were greater improvements found in tears greater than 3cm long with the double-row repair.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
4/4
Introduction
3/4
Accessing Data
4/4
Analysing Data
4/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Rotator cuff tears have a prevalence rate of 17% in the global population, yet an optimal arthroscopic treatment remains undecided. Single-row repairs are used most commonly; however, the reoccurrence rates can vary greatly and this technique may provide the opportunity for incomplete structural integrity. Some surgeons prefer the double-row technique presuming that a larger contact area between the tendon and the bone allow more fibers to participate in healing, resulting in superior biomechanical function. The reoccurrence rate after double-row procedures varies greatly and the clinical benefits are unclear. This meta-analysis was undertaken to compare the double-row and single-row techniques in the treatment of rotator cuff tears.
¿Cuál era la pregunta principal de la investigación?
Which technique, single-row or double-row arthroscopic rotator cuff repair, yielded improved clinical outcomes and healing in patients with rotator cuff tears?
- 12 studies were identified and the outcomes were pooled.
- An analysis of the trials with the highest level of evidence indicated no significant difference in CS scores (MD = 0.042, 95% CI, -0.15 to 0.23; P = 0.664, 5 studies) or ASES scores (MD = 0.12, 95% CI, -0.09 to 0.33; P = 0.26, 4 studies). The heterogeneity was not significant.
- 5 studies suggest the double row repair resulted in increased UCLA shoulder rating scores (p = 0.006), although this finding is statistically significant the authors state it is not clinically significant.
- The RCT's also indicated a significant improved in overall odds ratio of healing (OR, 1.93; 95% CI, 1.17 to 3.18; P =0.01, 5 studies) in favour of the double-row repair.
- When examining studies of every level of evidence, similar results were found; no differences were found in CS score (MD = 0.05, 95% CI -0.11 to 0.20; P = 0.566)) or ASES score (MD = 0.13, 95% CI -0.03 to 0.29; P = 0.102) yet, the UCLA score and healing rate were both in favour of the double-row repair [(MD = 0.21, 95% CI -0.03 to 0.38; P = 0.02) and (OR = 1.87, 95% CI 1.30 to 2.68; P = 0.001) respectively].
- A subgroup analysis of tears less than 3cm long demonstrated no difference in Constant score (p= .951), ASES score (p= 0.654), UCLA score (p=0.316), or intact tendon healing (p=0.32).
- Tears greater than 3 cm long however, showed significant benefit from the double-row repair in the ASES test (MD = 0.70, 95% CI 0.31 to 1.10; P = 0.001), the UCLA test (MD = 0.65, 95% CI 0.18 to 1.12; P = 0.007), however the differences were not clinically significant. This subgroup analysis also identified a significant difference in intact tendon healing (OR = 3.44, 95% CI 1.09 to 10.88; P = 0.035).
¿Qué es lo que más debo recordar?
There were statistically significant advantages found in the clinical and functional outcomes of the double-row repair, such as improvements in the University of California, Los Angeles shoulder rating scale and overall odds ratio for tending healing, however, these findings were not clinically significant. Also, tears that were greater than 3cm long showed improvements in both these tests as well as in the American Shoulder and Elbow Surgeons score.
¿Cómo afectará esto al cuidado de mis pacientes?
This study suggests that the double-row repair may provide favourable results compared to the single-row repair, however, these differences do not appear to be clinically significant. The results from the meta-analysis indicate the need for further research to be undertaken examining the treatment of different sized tears or tear locations. Also note that not all of statistically significant findings are clinically significant.
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