SHOULDER & ELBOW
Meta-analysis comparing single-row and double-row repair techniques in the arthroscopic treatment of rotator cuff tears
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(10):33 J Shoulder Elbow Surg. 2014 Feb;23(2):182-8. doi: 10.1016/j.jse.2013.08.005. Epub 2013 Oct 31Nine studies (5 level I evidence and 4 level II evidence) were included in this review which compared the clinical outcomes of single-row and double-row arthroscopic rotator cuff repair. Pooled results indicated significant differences in favour of double-row repair when considering re-tear rate, function on the American Shoulder and Elbow Surgeons (ASES) score, and range of motion in internal rotation. No significant differences were established for overall Constant score, UCLA score, range of motion in external rotation and forward flexion, and muscle strength. Double-row tended to be better for large-massive tears (>30mm).
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?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Arthroscopic rotator cuff repair has become increasingly popular in the management of torn cuff tendons. Standard intervention has predominantly been through the single-row technique. Despite good clinical results, there has been debate about whether the single-row technique offers sufficient anatomic healing. Accordingly, some suggest the double-row technique may be better suited, with an increased tendon-bone contact area and more anatomic footprint. How the clinical results compare between these two techniques needs to be investigated.
主な研究課題は何ですか？
Is there a difference in clinical results between single-row and double-row arthroscopic rotator cuff repair?
重要な知見は？
- The search and study selection yielded a total of 9 studies for inclusion (5 Level I; 4 Level II), comprising a total of 651 patients.
- Pooling of 7 studies indicated there was no significant difference in the comparison of Constant score between double-row and single-row repair (MD -0.31 [95%CI -2.71, 2.09]; p=0.80). Significance did not change based on analysis by subgroup (Small-Medium: MD -0.23 [95%CI -1.78, 1.31]; p=0.77) (Large-Massive: MD 2.41 [95%CI -1.95, 6.76]; p=0.28).
- Pooled UCLA scores (5 studies) demonstrated no significant difference between double-row and single-row (MD -0.64 [95%CI -0.22, 1.50]; p=0.14). By subgroups, there remained no significant difference in small-medium tears (2 studies: p=0.66), although scores in large-massive tears were significantly higher with double-row repair (3 studies: MD 1.48 [95%CI 0.44, 2.51]; p=0.005).
- ASES scores were pooled among 5 studies, indicating significantly higher scores with double-row repair (MD 1.22 [95%CI 0.39, 2.05]; p=0.004). The difference in small-medium tears was not significant (3 studies: p=0.29), whereas the difference in large-massive tears was significantly in favour of double-row repair (3 studies: MD 2.08 [95%CI 0.84, 3.32]; p=0.001).
- Pooled re-tear rates (5 studies) were 30/126 following double-row repair (23.8%) and 53/132 after single-row repair (40.2%). The difference between groups was statistically significant (RR 0.59 [95%CI 0.41, 0.86]; P=0.006).
- A significant difference in favour of double-row repair was observed in pooling of 2 studies for range of internal rotation (p<0.00001), although no difference was observed among 3 studies which reported data on range of external rotation (p=0.16) and 2 studies which reported data on range of forward elevation (p=0.97).
- There were no significant differences between double-row and single-row observed in the analyses of abduction muscle strength (p=0.73), external rotation muscle strength (p=0.81), and internal rotation muscle strength (p=0.21).
最も覚えておくべきことは？
Double-row arthroscopic repair of torn rotator cuff tendons was associated with a significantly lower re-tear rate, improved ASES score, and greater internal rotation. Large to massive tears additionally benefited from double-row repair, with improved UCLA scores. Constant score, range of motion in external rotation and forward elevation, and muscle strength were similar between double-row and single-row repair.
それが私の患者ケアにどのように影響するか？
The results of this analysis highlight the potential benefits of double-row repair in the treatment of rotator cuff tears, particularly those above 30mm. Objective analyses using MRI findings should be considered to further investigate any differences in treatment effects between double- and single-row repairs.
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