Purpose
The purpose of this study was to perform a network meta-analysis of the randomized
controlled trials (RCTs) in the literature in order to assess the evidence defining
the optimal combination of surgical technique single-row repair (SRR), double-row
repair (DRR), or transosseous-equivalent/suture bridge (TOE/SB) arthroscopic rotator
cuff repair (ARCR) and postoperative rehabilitation (early or late) protocol for ARCR.
Methods
The literature search was performed based on the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines. Randomized SSR-early trials (RCTs) comparing
SRR vs DRR vs TOE/SB ARCR techniques were included, as well as early vs late postoperative
range of motion. Clinical outcomes were compared using a frequentist approach to network
meta-analysis, with statistical analysis performed using R. The treatment options
were ranked using the P-score.
Results
Twenty-eight studies comprising 2,181 total shoulders met the inclusion criteria.
TOE/SB-late (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.08-0.46) and DRR-late
(OR, 0.25; 95% CI, 0.12-0.52) were found to significantly reduce the rate of retear,
with TOE/SB-late resulting in the highest P-score for the American Shoulder and Elbow
Surgeons (P-score: 0.7911) score and retear rate (P-score: 0.8725). DRR-early did
not result in any significant improvements over the SRR-early group, except in internal
rotation. There was no significant difference in forward flexion between groups, with
almost equivalent P-scores. Furthermore, TOE/SB-early and TOE/SB-late trended toward
worsening external rotation compared with the control.
Conclusions
The current study suggests that rotator cuff repair using the TOE/SB technique and
late postoperative mobilization yields the highest functional outcomes and lowest
retear rate in the arthroscopic management of symptomatic rotator cuff tears.
Level of Evidence
Level I, meta-analysis of Level I studies.
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Article Info
Publication History
Published online: May 31, 2021
Accepted:
May 12,
2021
Received:
July 8,
2020
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
