SHOULDER & ELBOW
Single-row or double-row fixation technique for full-thickness rotator cuff tears: a meta-analysis
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(16):33 PLoS One. 2013 Jul 11;8(7):e68515. doi: 10.1371/journal.pone.0068515. Print 2013Eight Level I and II publications (6 RCTs and 2 prospective cohort studies) were included in this meta-analysis which compared double-and single-row arthroscopic rotator cuff repair. The pooled results indicated that functional outcomes measured were superior in those who had received double-row repair, however this was primarily in patients presenting with large tears. Postoperative cuff integrity and a reduced risk of partial-thickness retear were also associated with double-row repair. For small tears that were less than 3 cm there were no differences in outcomes between double and single row repairs.
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?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
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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
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Rotator cuff tears represent one of the common pathologies of the shoulder, and their effect on daily life can be particularly debilitating. Many individuals elect to undergo arthroscopic repair in order to treat the condition. For surgery, single- and double-row techniques have been described and are performed routinely, although debate still exists about whether the increased tendon-bone contact area achieved with double-row repair actually translates into a clinical difference.
Was war die wichtigste Forschungsfrage?
Did double-row repair offer a better clinical outcome compared to single-row repair in the treatment of rotator cuff tears?
Was waren die wichtigsten Ergebnisse?
- Pooling of Constant scores across all types of tears (5 studies) indicated no significant difference between double- and single-row repair (MD -1.00 (95%CI -2.37 to 0.37); P=0.15). Non-significant differences were also observed when analyzed by small tears (MD 0.06 (95%CI -1.72 to 1.85); P=0.95) and large tears (MD -4.57 (95%CI -10.39 to 1.24); P=0.12).
- ASES scores overall were significantly better with double-row repair compared to single-row (6 studies)(MD -0.84 (95%CI -1.66 to -0.02); P=0.04). This was primarily among large tears (MD -1.95 (95%CI -3.14 to -0.76); P=0.001). No significant difference was demonstrated in small tears (MD -0.14 (95%CI -1.12 to 0.84); P=0.77).
- UCLA scores overall were significantly better with double-row repair compared to single-row (4 studies) (MD -0.75 (95%CI -1.30 to -0.20); P=0.007). This finding was considerably due to improvement seen in large tears (MD -1.17 (95%CI -2.01 to -0.33); P=0.006). The difference between treatments among small tears was not significant (MD -0.44 (95%CI -1.17 to 0.29); P=0.24).
- Postoperative rotator cuff integrity was determined to be significantly better in groups which received double-row repair compared to single-row repair (RR 0.81 (95%CI 0.72-0.91); P=0.0004). Classification system(s) used to assess cuff integrity radiographically was not reported.
- Risk of partial thickness retear was significantly higher among those who received single-row repair (RR 1.93 (95%CI 1.20-3.11); P=0.007). There was no significant difference between techniques regarding the risk of full-thickness retear (RR 1.45 (95%CI 0.88-2.41); P=0.15).
Was sollte ich mir besonders merken?
Functional outcome measurements of the ASES and UCLA scores were significantly better among patients who received double-row repair, particularly in those with large tears. No significantly functional differences were seen in the Constant score, and in those who presented with small tears between single and double row repair. Double-row repair also demonstrated better postoperative cuff integrity, and possessed a lower risk of partial retear compared to single-row repair.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
Double-row repair appears to offer superior clinical outcome for rotator cuff tears, however this may only be primarily in patients presented with large tears as opposed to small tears. Future trials which clearly analyze and report the potential difference in outcome regarding tear size are crucial to this topic going forward.
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