All-arthroscopic versus mini-open repair of small to large sized rotator cuff tears: a meta-analysis of clinical outcomes.
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ABSTRACT: Purpose
The purpose of this study was to compare clinical outcomes of patients with full-thickness small to large sized tears undergoing all-arthroscopic versus mini-open rotator cuff repair.Method
A literature search for electronic databases and references for eligible studies was conducted through Medline, Embase and Cochrane library between 1969 and 2013.Results
A total of 12 comparative studies (n = 770 patients) were included. Pooled results showed: there were no differences in function outcome, pain scores, retear rate or the incidence of adhesive capsulitis between all arthroscopic and mini-open repair groups.Conclusions
There were no differences in outcomes between the arthroscopic and mini-open rotator cuff repair techniques, they should be considered alternative treatment options.Level of evidence
Level IV, Meta analysis.
PROVIDER: S-EPMC3984182 | BioStudies |
REPOSITORIES: biostudies
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Project description:Despite advances in surgical technology, as well as generally good outcomes, repairs of full-thickness rotator cuff tears show a retear rate of 25% to 57% and may fail to provide full return of function. The repairs tend to fail at the suture-tendon junction, which is due to several factors, including tension at the repair site, quality of the tendon, and defective tissue repair. One strategy to augment repair of large to massive rotator cuff tears is the development of biological scaffold materials, composed of extracellular matrix (ECM). The goal is to strengthen and evenly distribute the mechanical load across the repair site, thus minimizing the rupture risk of the native tendon while providing the biological elements needed for healing. The promising results of ECM-derived materials and their commercial availability have increased their popularity among shoulder surgeons. In contrast to a traditional open or arthroscopically assisted mini-open approach, this completely arthroscopic technique offers the full advantages warranted by the use of a minimally invasive approach. This technical guide describes arthroscopic rotator cuff repair using an ECM graft technique.
2014-01-01 | S-EPMC4175541 | BioStudies
Project description:The objective of this study was to compare outcomes in patients with rotator cuff tears undergoing all-arthroscopic versus mini-open rotator cuff repair. A systematic review and meta-analysis of outcomes of all-arthroscopic repair versus mini-open repair in patients with rotator cuff repair was conducted. Studies meeting the inclusion criteria were screened and included from systematic literature search for electronic databases including Medline, Embase, Cochrane CENTRAL, and CINAHL library was conducted from 1969 and 2015. A total of 18 comparative studies including 4 randomized clinical trials (RCTs) were included. Pooled results indicate that there was no difference in the functional outcomes, range of motion, visual analog scale (VAS) score, and short-form 36 (SF-36) subscales. However, Constant-Murley functional score was found to be significantly better in patients with mini-open repair. However, the results of the review should be interpreted with caution due to small size and small number of studies contributing to analysis in some of the outcomes. All-arthroscopic and mini-open repair surgical techniques for the management of rotator cuff repair are associated with similar outcomes and can be used interchangeably based on the patient and rotator tear characteristics.
2016-01-01 | S-EPMC4780011 | BioStudies
Project description:Introduction:Retrospective evaluation of rotator cuff repair with arthroscopic or arthroscopic-assisted mini-open methods for a diagnosis of non-retracted rotator cuff tear. Materials and methods:A total of 45 patients underwent rotator cuff repair; Group 1 (n?=?24) with arthroscopic-assisted mini-open method and Group 2 (n?=?21) with full arthroscopic method. Results:Within both Group 1 and Group 2, a statistically significant results is p?=?0.001. The patients of Group 2 were seen to return to daily life earlier than those of Group 1 (p?=?0.001). Conclusions:Patients where full arthroscopic repair was applied, there was evidence of an earlier return to daily life. Level of evidence:IV, retrospective comparative study.
| S-EPMC6118155 | BioStudies
Project description:The aim of the study was to compare the clinical outcomes of patients undergoing all-arthroscopic (AA) or mini-open (MO) rotator cuff repair.The present study evaluated 50 patients who had undergone AA repair and 50 patients who had undergone MO repair with a minimum 1-year follow-up. Every patient was asked to complete the Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS) questionnaires. Constant-Murley score (CMS) and active ranges, forward flexion and external rotation, were also evaluated and documented. One year after surgery, ultrasound evaluation was done to determine the integrity of the rotator cuff for each patient.The average age of enrolled patients at the time of surgery was 53.0 years (range, 40-59 years), and average follow-up was 16.6 months (range, 12-24 months). At 2 weeks, the range of forward flexion in the AA group was larger than that in the MO group (136.5?±?10.2 vs 132.5?±?7.7, P?=?0.03). On postoperative day 1, the VAS in the MO group was significantly higher than that in the AA group (6.5?±?0.6 vs 6.1?±?0.6, P?<?0.01). At 1 month, the difference in VAS between both groups reappeared (2.9?±?0.6 vs 2.6?±?0.6, P?=?0.03). At 1 month, the CMS score of patients in the AA group was higher than that in the MO group (52.8?±?3.6 vs 50.9?±?5.0, P?=?0.03). At 3 and 6 months, the DASH score of patients in the AA group was lower than that in the MO group (43.8?±?8.2 vs 47.8?±?4.4, P?<?0.01 and 38.6?±?4.3 vs 42.7?±?9.9, P?<?0.01, respectively). Mean operative time was longer in the AA group compared with that in the MO group (71.9?±?17.6 vs 64.7?±?12.7 minutes, P?<?0.01). Five patients (10.0%) in the AA group and 4 patients (8.2%) in the MO group had rotator cuff retear, and 6 patients (12.0%) in the AA group and 8 patients (16.3%) in the MO group had adhesive capsulitis by the end of follow-up. There is no significant difference between the 2 groups in the incidence of complications. We also found that joint exercising at least 3 times per week was associated with better short- and long-term joint function recovery.The AA approach was associated with less pain and lower DASH score as well as higher CMS score in the early recovery period. No difference was found between the 2 groups in primary and secondary outcomes in the long term, or incidence of complications such as adhesive capsulitis and rotator cuff retear. In conclusion, we consider that the AA procedure has better recovery at short-term follow-ups, while both techniques are equivalent regarding long-term outcomes.
2017-01-01 | S-EPMC5369905 | BioStudies
Project description:BACKGROUND:Increased interest in using platelet-rich plasma (PRP) as an augment to rotator cuff repair warrants further investigation, particularly in smaller rotator cuff tears. PURPOSE:To examine the effectiveness of PRP application in improving perioperative pain and function and promoting healing at 6 months after arthroscopic repair of small- or medium-sized rotator cuff tears. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:This was a double-blinded randomized controlled trial of patients undergoing arthroscopic repair of partial- or full-thickness rotator cuff tears of up to 3 cm who were observed for 6 months. Patients were randomized to either repair and PRP application (study group) or repair only (control group) groups. The patient-oriented outcome measures utilized were the visual analog scale (VAS), the Short Western Ontario Rotator Cuff Index (ShortWORC), the American Shoulder and Elbow Surgeons (ASES) form, and the Constant-Murley Score (CMS). Range of motion (ROM) and inflammatory and coagulation markers were measured before and after surgery. Magnetic resonance imaging was used at 6 months to assess retear and fatty infiltration rate. RESULTS:Eighty-two patients (41 males) with a mean age of 59 ± 8 years were enrolled; 41 patients were included in each group. Both the PRP and control groups showed a significant improvement in their pain level based on the VAS within the first 30 days (P < .0001), with the PRP group reporting less pain than the control group (P = .012), which was clinically significantly different from days 8 through 11. The PRP group reported taking less painkillers (P = .026) than the control group within the first 30 days. All outcome measure scores and ROM improved significantly after surgery (P < .0001), with no between-group differences. No differences were observed between groups in inflammatory or coagulation marker test results (P > .05), retear (14% vs 18% full retear; P = .44), or fatty infiltration rate (P = .08). CONCLUSION:The PRP biological augmentation for repair of small- to medium-sized rotator cuff tears has a short-term effect on perioperative pain without any significant impact on patient-oriented outcome measures or structural integrity of the repair compared with control group.
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Project description:OBJECTIVE:Delaminated rotator cuff tears are a common shoulder disorder in elderly individuals. Either arthroscopic separate double-layer repair (DR) or en masse repair (ER) is used to treat a delaminated rotator cuff tear. We conducted this systematic review and meta-analysis to compare the clinical outcomes of arthroscopic ER versus DR intervention. METHODS:Five studies were acquired from PubMed, Medline, Embase, CNKI, Google, and the Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed with RevMan 5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. The Cochrane Collaboration's risk of bias tool and Newcastle-Ottawa Scale were used to assess the risk of bias. RESULTS:Five studies, including two randomized controlled trials (RCTs) and three observational studies, were assessed. The methodological quality of the trials ranged from low to high. The pooled results for the Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score, visual analog scale (VAS) score, Constant score, and range of motion (ROM) showed that the outcomes were not statistically significant between the two interventions. The difference in retear rate was not statistically significant (OR = 0.69, 95% CI = 0.36-1.33, P = 0.27). The sensitivity analysis proved the stability of the pooled results, and publication bias was not apparent. CONCLUSIONS:Both arthroscopic ER and DR interventions had benefits in delaminated rotator cuff tear treatment. ER and DR treatments were equally effective and had the same retear rate. The arthroscopic DR technique could not be recommended as the optical choice for delaminated rotator cuff tears based on current evidence.
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Project description:We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair, and 32 patients underwent an arthroscopic rotator cuff repair. The mean follow-up period was 31 months in the mini-open group and 30.6 months in the arthroscopic group (P > 0.05). The UCLA rating system, range of motion examination and the self-administered SF-36 used for postoperative evaluation showed a statistically significant improvement from the preoperative to the final score for both groups (P < 0.05). No statistically significant difference in the total UCLA scores was found when comparing the two repair techniques (P > 0.05). This study suggests that there is no difference in terms of subjective and objective outcomes between the two surgical procedures studied if patients have rotator cuff tears of less than 3 cm.
2010-01-01 | S-EPMC2899299 | BioStudies
Project description:The prevalence of rotator cuff repair continues to rise, with a noted transition from open to arthroscopic techniques in recent years. One reported advantage of arthroscopic repair is a lower infection rate. However, to date, the infection rates of these 2 techniques have not been directly compared with large samples at a single institution with fully integrated medical records.To retrospectively compare postoperative infection rates between arthroscopic and open rotator cuff repair.Cohort study; Level of evidence, 3.From January 2003 until May 2011, a total of 1556 patients underwent rotator cuff repair at a single institution. These patients were divided into an arthroscopic repair group and an open group. A Pearson chi-square test and Fisher exact test were used, with a subgroup analysis to segment the open repair group into mini-open and open procedures. The odds ratio and 95% CI of developing a postoperative infection was calculated for the 2 groups. A multiple-regressions model was then utilized to identify predictors of the presence of infection. Infection was defined as only those treated with surgical intervention, thus excluding superficial infections treated with antibiotics alone.A total of 903 patients had an arthroscopic repair, while 653 had open repairs (600 mini-open, 53 open). There were 4 confirmed infections in the arthroscopic group and 16 in the open group (15 mini-open, 1 open), resulting in postoperative infection rates of 0.44% and 2.45%, respectively. Subgroup analysis of the mini-open and open groups demonstrated a postoperative infection rate of 2.50% and 1.89%, respectively. The open group had an odds ratio of 5.645 (95% CI, 1.9-17.0) to develop a postoperative infection compared with the arthroscopic group.Patients undergoing open rotator cuff repair had a significantly higher rate of postoperative infection compared with those undergoing arthroscopic rotator cuff repair.
2017-01-01 | S-EPMC5524237 | BioStudies
Project description:OBJECTIVE:To assess the effectiveness of arthroscopic versus mini-open rotator cuff repair on function, pain and range of motion at 3-, 6- and 12-month follow ups. DESIGN:Systematic review and meta-analysis of randomized controlled trials. SETTING:Clinical setting. PARTICIPANTS:Patients 18 years and older with a rotator cuff tear. INTERVENTION/COMPARISON:Arthroscopic/mini-open rotator cuff repair surgery followed by post operative rehabilitation. MAIN OUTCOME MEASURES:Function and pain. RESULTS:Six RCTs (n = 670) were included. The pooled results, demonstrated no significant difference between arthroscopic and mini open approach to rotator cuff repair on function (very low quality, 4 RCTs, 495 patients, SMD 0.00, 3-month; very low quality, 4 RCTs, 495 patients, SMD -0.01, 6-month; very low quality, 3 RCTs, 462 patients, SMD -0.09, 12-months). For pain, the pooled results, were not statistically different between groups (very low quality, 3 RCTs, 254 patients, MD -0.21, 3-month; very low quality, 3 RCTs, 254 patients, MD -0.03, 6-month; very low quality, 2 RCTs, 194 patients, MD -0.35, 12-months). CONCLUSION:The effects of arthroscopic compared to mini-open rotator cuff repair, on function, pain and range of motion are too small to be clinically important at 3-, 6- and 12-month follow ups.
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Project description:Patients with rotator cuff tears may present with or subsequently develop concomitant shoulder stiffness. The treatment of rotator cuff tears in the face of passive glenohumeral motion loss is controversial. Preoperative shoulder stiffness has been considered by some a contraindication to rotator cuff repair. Some surgeons recommend staging surgical procedures and delaying rotator cuff repair until shoulder stiffness has resolved. However, this can lead to prolonged recovery times and patient dissatisfaction. We describe a surgical technique that allows for the single-stage arthroscopic management of rotator cuff tears with associated adhesive capsulitis. Arthroscopic capsular release and shoulder manipulation are performed in the same operative setting as arthroscopic rotator cuff repair. We have found that this combined, single-stage arthroscopic approach can effectively treat patients with rotator cuff tears and concomitant shoulder stiffness.
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