SHOULDER & ELBOW
Tenotomy or tenodesis for the long head of biceps lesions in shoulders: a systematic review and meta-analysis
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(24):27 PLoS One. 2015 Mar 18;10(3):e0121286Seven studies (3 randomized controlled trials; 4 cohort studies) were included in this meta-analysis comparing tenodesis and tenotomy in the management of patients with lesions of the long head of the biceps tendon. Meta-analysis was performed on Constant score, complications, satisfaction, and operative time. Qualitative assessment was undertaken for postoperative range of motion. Tenodesis demonstrated higher postoperative Constant scores and lower rates of cramp pain and Popeye deformity, while no significant differences were observed in satisfaction or range of motion. Operative time was significantly shorter for tenotomy.
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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?
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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？
Long head of the biceps tendon lesions are common, particularly as individuals age. Surgery is indicated if conservative treatment can not manage symptoms. Tenotomy or tenodesis may be performed and are typically successful, though both are associated with their own advantages and disadvantages. As such, surgeons are split between which should be performed, and whether one option is superior to the other.
主な研究課題は何ですか？
Is there a significant difference in clinical or functional outcome between tenotomy and tenodesis in patients with long head of the biceps tendon (LHBT) lesions?
重要な知見は？
- Constant scores were significantly higher with tenodesis versus tenotomy (5 studies; MD 2.84 [95%CI 0.37, 5.31]; p=0.02).
- Qualitative assessment of range of motion from three studies was undertaken, with all reporting no significant difference between tenodesis and tenotomy groups.
- Tenodesis demonstrated significantly lower rates of cramp pain (4 studies; RR 0.51 [95%CI 0.26, 0.98]; p=0.04) and Popeye deformity (7 studies; RR 0.18 [ 95%CI 0.11, 0.30]; p<0.00001). Rate of satisfaction was similar between groups (4 studies; RR 1.00 [095%CI 0.92, 1.09]; p=0.94).
- Tenotomy demonstrated a significantly shorter operative time compared to tenodesis (3 studies; MD 10.54 [95%CI 8.96, 12.12]; p<0.00001).
最も覚えておくべきことは？
Tenodesis demonstrated significantly higher postoperative Constant score and lower incidences of cramp pain and Popeye deformity compared to tenotomy in patients with long head of the biceps tendon lesions. Tenotomy took significantly less time to complete compared to tenodesis. Range of motion postoperative did not appear to significantly differ between tenodesis and tenotomy, and patients were generally satisfied with either surgical treatment.
それが私の患者ケアにどのように影響するか？
The results of this meta-analysis suggest that despite having increased surgical time, tenodesis may have improved functional outcomes after surgery for lesions of the long head of the biceps tendon, and may also reduce the risk of associated painful cramping and Popeye deformity. Additional, randomized controlled trials should be considerd to further add to the body of evidence comparing these two methods of treatment.
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