Surgical repair VS acromioplasty and physiotherapy in non-traumatic rotator cuff tear .
Este estudio ha sido identificado como potencialmente de alto impacto.
La métrica de alto impacto de OE, impulsada por la IA, estima la influencia que probablemente tendrá un artículo integrando señales tanto de la revista en la que se publica como del contenido científico del propio artículo.
Desarrollado mediante el procesamiento del lenguaje natural más avanzado, el modelo de Alto Impacto de OE predice con mayor precisión el futuro rendimiento de las citas de un estudio que el factor de impacto de la revista por sí solo.
Esto permite reconocer antes las investigaciones clínicamente significativas y ayuda a los lectores a centrarse en los artículos con más probabilidades de configurar la práctica futura.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(9):15 Bone Joint J. 2014 Jan;96-B(1):75-81. doi: 10.1302/0301-620X.96B1.32168.Patients (180 shoulders) above 55 years of age with non-traumatic supraspinatus tears were analyzed one year post-intervention to determine if rotator cuff repair is superior to alternative treatment approaches. Patients were randomly allocated to a physiotherapy group, acromioplasty and physiotherapy group, or rotator cuff repair, acromioplasty and physiotherapy group and evaluated for outcome using the Constant score. Results revealed that rotator cuff repair did not yield superior results compared to acromioplasty and/or physiotherapy. Surgical interventions were associated with significantly greater costs than physiotherapy alone.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
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.
2/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
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 can be categorized as traumatic or non-traumatic in origin, with non-traumatic tears being prevalent in the majority of individuals over 55 years of age. While surgical repair is often encouraged for non-traumatic rotator cuff tears in this age group, there remains a lack of comparative evidence to alternative treatment methods, such as acromioplasty and conservative treatment. To determine the efficacy of non-traumatic rotator cuff tears, different treatments options for patients above 55 years of age were compared one year post-intervention.
¿Cuál era la pregunta principal de la investigación?
Does rotator cuff repair yield superior results in terms of Constant score when compared to acromioplasty and/or physiotherapy treatments one year post-intervention?
- Mean Constant scores were 74.1 (SD 14.2) in group 1, 77.2 (SD 13.0) in group 2, and 77.9 (SD 12.1) in group 3 (p=0.34) at 1 year.
- There was a significant difference between groups terms of pain (p=0.0321) and activities of daily living (p<0.0001), with higher scores registered in the repair group and acromioplasty group compared to physiotherapy alone. Constant sub-scores in range of movement (p=0.74) and strength (p=0.76) did not differ significantly between groups.
- Percent of patients satisfied with their assigned intervention at 1 year follow up was 87% in group 1, 96% in group 2 and 95% in group 3 (p=0.14).
- Cost associated with treatment was an average 2417 euro (SD 1443) for physiotherapy, 4765 euro (SD 896) for acromioplasty and physiotherapy, and 5709 euro for repair, acromioplasty, and physiotherapy (p<0.0001). Costs were mainly attributable to indirect societal cost (including operation, supplies, patient care), which averaged 2130, 4486 and 5461 euro in each group, respectively (p<0.0001).
- Four patients (4 shoulders; 7.3%) who received physiotherapy and 1 patient (1 shoulder; 1.8%) who received acromioplasty and physiotherapy underwent rotator cuff repair after a mean 0.7 years (0.65-0.76).
- Intraoperatively, additional AC resection was performed in 7 shoulders (12%) allocated to acromioplasty and 8 shoulders (15%) allocated the repair and acromioplasty. Biceps tenotomy was performed in 29 shoulders (51%) and 23 shoulders (42%) of these groups, respectively.
¿Qué es lo que más debo recordar?
In the treatment of non-traumatic supraspinatus tears in patients above the age of 55, there was no significant difference in functional outcome or patient satisfaction after 1 year between physiotherapy, acromioplasty and physiotherapy, or repair, acromioplasty and physiotherapy. Costs associated with surgical interventions were significantly higher than physiotherapy alone.
¿Cómo afectará esto al cuidado de mis pacientes?
Based on these findings, this study suggests that a conservative treatment method with physiotherapy may be as effective as surgery, either through acromioplastry and/or repair, for non-traumatic rotator cuff tears in older patients, and that lower costs with physiotherapy may be more apt in primary treatment. It is recommended studies with longer follow up times confirm the validity of these findings.
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