Peripheral Nerve Blocks Outperform General Anesthesia for Pain Control in Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-Analysis

IntroductionBone marrow-stimulating (BMS) techniques during arthroscopic rotator cuff repair surgery theoretically enhance the biological component for healing and hence improve tendon healing, but their efficacy remains unproven. The purpose of this review is to determine the effects and associated harms of BMS in arthroscopic rotator cuff repair surgery.Methods and analysisWe will perform a systematic review and meta-analysis of randomised-controlled trials (RCTs) and retrospective cohort studies (RCS) that compare outcomes following BMS use against no use of BMS during arthroscopic rotator cuff repair surgery. We will search the databases including the Cochrane Central Register of Controlled Trials, Medline and Embase, and clinical trial registries for relevant studies. We will include studies published from start of indexing until 23 August 2018. Two reviewers will independently assess the eligibility for studies. For each included trial, we will conduct duplicate independent data extraction and risk of bias assessment. We will use the Cochrane Collaboration tool to assess the risk of bias of included RCTs, while we will use the Risk Of Bias In Non-randomised Studies - of Interventions tool to evaluate the risk of bias of RCS. We will perform a random-effects meta-analysis in calculating the pooled risk estimates when appropriate. We will assess the overall quality of the data for each individual outcome using the Grading of Recommendations, Assessments, Development and Evaluation approach. The primary outcomes are tendon healing rate, overall pain and shoulder functions. The secondary outcomes are the proportion of participants with adverse events related to interventions, the range of motion and the proportion of participants with return to previous activities.Ethics and disseminationWe will report this review according to the guidance of the PRISMA statement. The results of this review will be disseminated through conference presentations and publications in peer-reviewed journals.PROSPERO registration numberCRD42018087161.

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Outcomes of Single-Row Versus Double-Row Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-Analysis of Current Evidence

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2013.03.076 ◽

2013 ◽

Vol 29 (8) ◽

pp. 1437-1449 ◽

Cited By ~ 75

Author(s):

Ming Chen ◽

Wei Xu ◽

Qirong Dong ◽

Qun Huang ◽

Zonggang Xie ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Meta Analysis ◽

Arthroscopic Rotator Cuff Repair ◽

Current Evidence ◽

Double Row ◽

Single Row ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

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Use of Suture Tapes Versus Conventional Sutures for Arthroscopic Rotator Cuff Repairs: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546521998318 ◽

2021 ◽

pp. 036354652199831

Author(s):

Khalis Boksh ◽

Aziz Haque ◽

Ashwini Sharma ◽

Pip Divall ◽

Harvinder Singh

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Clinical Studies ◽

Rotator Cuff Repair ◽

Meta Analysis ◽

Gap Formation ◽

Load To Failure ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair ◽

Suture Tape

Background: Various suture materials are available for arthroscopic rotator cuff repair. More recently, suture tapes have become popular as they are perceived to be easier to use with less soft tissue irritation. However, little is known about their biomechanical and clinical properties compared with conventional sutures in rotator cuff repairs. Purpose: To perform a systematic review and meta-analysis on whether suture tapes are biomechanically superior to conventional sutures in arthroscopic rotator cuff repairs and whether this translates to superior functional outcomes and a lower incidence of retears. Study Design: Meta-analysis. Methods: The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: (rotator cuff repair OR arthroscopic rotator cuff repair) AND (“tape” OR “wire” OR “cord” OR “suture”). Data pertaining to certain biomechanical properties (contact area, contact pressure, gap formation, load to failure, and stiffness), retears, and patient-reported outcome measures (PROMs) were extracted. The pooled outcome data were analyzed by random- and fixed-effects models. Results: After abstract and full-text screening, 7 biomechanical and 6 clinical studies were included. All biomechanical studies were on animals, with 91 suture tapes and 91 conventional sutures compared. Suture tapes had higher contact pressure (mean difference [MD], 0.04 MPa; 95% CI, 0.01-0.08; P = .02), higher load to failure (MD, 52.62 N; 95% CI, 27.34-77.90; P < .0001), greater stiffness (MD, 4.47 N/mm; 95% CI, 0.57-8.38; P = .02), and smaller gap formation (MD, −0.30 mm; 95% CI, −0.45 to −0.15; P < .0001) compared with conventional sutures. From the clinical analysis of the 681 rotator cuff repairs treated with a suture tape (n = 380) or conventional suture (n = 301), there were no differences in retear rates between the groups (16% vs 20% suture tape and wire, respectively; P = .26) at a mean of 11.2 months. Qualitatively, there were no differences in PROMs between the groups at a mean of 36.8 months. Conclusion: Although biomechanically superior, suture tapes showed similar retear rates and postoperative function to conventional sutures. However, higher-quality clinical studies are required to investigate whether there are no true differences.

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Return to Sport After Arthroscopic Rotator Cuff Repair: Is There a Difference Between the Recreational and the Competitive Athlete?

The American Journal of Sports Medicine ◽

10.1177/0363546519825624 ◽

2019 ◽

Vol 48 (1) ◽

pp. 252-261 ◽

Cited By ~ 3

Author(s):

Burak Altintas ◽

Nicole Anderson ◽

Grant J. Dornan ◽

Robert E. Boykin ◽

Catherine Logan ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Meta Analysis ◽

Return To Sport ◽

Arthroscopic Rotator Cuff Repair ◽

Recreational Athletes ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Return to sport (RTS) remains an important challenge and measure of success for athletes undergoing arthroscopic rotator cuff repair (RCR). Purpose: To determine the rate of RTS after RCR and to analyze predictive factors associated with a lower rate of return. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed, MEDLINE, Cochrane, and Google Scholar were used for the literature search. Study quality was evaluated according to the Coleman Methodology Score. Studies in English evaluating RTS after arthroscopic repair of partial- or full-thickness rotator cuff tears among athletes of all levels, ages, and sports were included. Random effects meta-analysis and metaregression were performed to investigate RTS activity rate after arthroscopic RCR and to explore study heterogeneity, respectively. Results: Fifteen studies were reviewed, including 486 patients (499 shoulders) who were treated with arthroscopic RCR and who had a mean follow-up of 40.1 months (range, 18-74.4 months). Eighteen patients were lost to follow-up, leaving 468 patients with outcome data; 347 identified themselves as athletes (81 competitive, 266 recreational). The most commonly included sports were baseball (n = 45), golf (n = 38), football (n = 23), and tennis (n = 18). RTS specific to the type of athlete was reported for 299 of 347 athletes. According to the meta-analysis, the overall rate of RTS at a similar level of play or higher was 70.2%, with 73.3% of recreational athletes and 61.5% of competitive athletes able to return. A subset of 43 baseball and softball players across 4 studies yielded a 79% rate of RTS; however, only 38% returned to the same level of play or higher. Subgroup meta-analysis revealed no significant difference in the rate of RTS between competitive and recreational athletes. Metaregression analysis revealed that the mean follow-up time and mean age at surgery were not significantly associated with RTS rate. Conclusion: Most athletes (70.2%) were able to return to a preinjury level of play after arthroscopic RCR. While recreational sports participation (73.3%) was associated with higher return, competitive sports (61.5%) and overhead sports (38%) were associated with lower return. Exactly why all athletes do not return remains uncertain and likely multifactorial.

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Conservative versus accelerated rehabilitation after rotator cuff repair: a systematic review and meta-analysis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04397-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Umile Giuseppe Longo ◽

Laura Risi Ambrogioni ◽

Alessandra Berton ◽

Vincenzo Candela ◽

Filippo Migliorini ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

External Rotation ◽

Meta Analysis ◽

Conservative Group ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair ◽

Retear Rate

Abstract Background The purpose of this systematic review and meta-analysis is to compare the conservative and accelerated rehabilitation protocols in patients who underwent arthroscopic rotator cuff repair in terms of clinical outcomes and range of motions at 3, 6, 12, and 24-month follow-up. Methods According to PRISMA guidelines, a systematic review of the literature was performed. For each included article, the following data has been extracted: authors, year, study design, level of evidence, demographic characteristics, follow-up, clinical outcomes, range of motions, and retear events. A meta-analysis was performed to compare accelerated versus conservative rehabilitation protocols after arthroscopic rotator cuff repair. The retear rate, postoperative Constant-Murley score and range of motions at 3, 6, 12, and 24 months of follow-up were the outcomes measured. Results The search strategy yielded 16 level I-II clinical studies. A total of 1424 patients, with 732 patients and 692 in the accelerated and conservative group, were included. The average age (mean ± standard deviation) was 56.1 ± 8.7 and 56.6 ± 9 in the accelerated and conservative group. The mean follow-up was 12.5 months, ranging from 2 to 24 months. The meta-analysis showed no statistically significant differences in terms of retear rate between the groups (P = 0.29). The superiority of the accelerated group was demonstrated in terms of external rotation (P < 0.05) at 3-month follow-up; in terms of forward elevation, external rotation, abduction (P < 0.05), but not in terms of Constant-Murley score at 6-month follow-up; in terms of forward elevation (P < 0.05) at 12-month follow-up. No significant differences between the two group were highlighted at 24-month follow-up. Conclusions No statistically significant differences in the retear rate among the accelerated and conservative group have been demonstrated. On the other hand, statistically and clinically significant differences were found in terms of external rotation at 3 and 6 months of follow-up in favour of the accelerated group. However, no differences between the two groups were detected at 24 months follow-up.

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