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.
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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?
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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？
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.
主な研究課題は何ですか？
Did double-row repair offer a better clinical outcome compared to single-row repair in the treatment of rotator cuff tears?
重要な知見は？
- 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).
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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