Comparison of Multiple Surgical Treatments for Massive Irreparable Rotator Cuff Tears in Patients Younger Than 70 Years of Age: A Systematic Review and Network Meta-analysis
Background: Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis. Purpose: To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients
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| Veröffentlicht in: | The American journal of sports medicine 2024-09, Vol.52 (11), p.2919-2930 |
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| container_title | The American journal of sports medicine |
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| creator | Bi, Andrew S. Anil, Utkarsh Colasanti, Christopher A. Kwon, Young W. Virk, Mandeep S. Zuckerman, Joseph D. Rokito, Andrew S. |
| description | Background:
Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis.
Purpose:
To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients |
| doi_str_mv | 10.1177/03635465231204623 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2920572978</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_03635465231204623</sage_id><sourcerecordid>2920572978</sourcerecordid><originalsourceid>FETCH-LOGICAL-c368t-d6542d388e9b700e200503ccab2ccf269f0a66977c47c553256e56162435fae43</originalsourceid><addsrcrecordid>eNp10c9uEzEQBnALUdHQ8gBckCUuXLb4z9re5RZFQCs1BbXpoafVxJkNLrvrYHtb5aH6jjhNAQnEyYf5fTOWPkJec3bCuTHvmdRSlVoJyQUrtZDPyIQrJQoptXpOJrt5sQOH5GWMt4wxbnT1ghzKStS8rtWEPMx8v4Hgoh-ob-l87JLbdEivxrB2Fjq6CAipxyFF2vpA5xCju0N6FgLmHCyzvfQJUp7NxralC4QQqRvoV0juMXbjx2GNgS6-wUANozePIh-brvEDndKrbUzYZ23pJd45vKcwrOgFpnsfvtM5JihggG4bXTwmBy10EV89vUfk-tPHxey0OP_y-Ww2PS-s1FUqVlqVYiWrCuulYQwFY4pJa2EprG2FrlsGWtfG2NJYpaRQGpXmWpRStYClPCLv9ns3wf8YMaamd9Fi18GAfoyNqAVTRtSmyvTtX_TWjyH_NzaSc651JbnOiu-VDT7GgG2zCa6HsG04a3ZdNv90mTNvnjaPyx5XvxO_ysvgZA8irPHP2f9v_Al70qaj</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3111668316</pqid></control><display><type>article</type><title>Comparison of Multiple Surgical Treatments for Massive Irreparable Rotator Cuff Tears in Patients Younger Than 70 Years of Age: A Systematic Review and Network Meta-analysis</title><source>MEDLINE</source><source>SAGE Complete A-Z List</source><source>Alma/SFX Local Collection</source><creator>Bi, Andrew S. ; Anil, Utkarsh ; Colasanti, Christopher A. ; Kwon, Young W. ; Virk, Mandeep S. ; Zuckerman, Joseph D. ; Rokito, Andrew S.</creator><creatorcontrib>Bi, Andrew S. ; Anil, Utkarsh ; Colasanti, Christopher A. ; Kwon, Young W. ; Virk, Mandeep S. ; Zuckerman, Joseph D. ; Rokito, Andrew S.</creatorcontrib><description>Background:
Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis.
Purpose:
To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients <70 years of age for several patient-reported outcomes, range of motion (ROM), and acromiohumeral distance (AHD).
Study Design:
Network meta-analysis of comparative studies; Level of evidence, 3.
Methods:
A systematic review of the literature, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the MEDLINE, Embase, and Cochrane Library databases was conducted from 2017 to 2022. Inclusion criteria were (1) clinical comparative studies of MIRCTs (with several study-specific criteria); (2) ≥1 outcome of interest reported on, with standard deviations; (3) minimum 1-year follow-up; and (4) mean age of <70 years for both cohorts, without arthritis or pseudoparalysis. There were 8 treatment arms compared. Outcomes of interest were the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, visual analog scale for pain, AHD, and forward flexion and external rotation ROM. A frequentist approach to network meta-analysis with a random-effects model was performed using the netmeta package Version 0.9-6 in R.
Results:
A total of 23 studies met the inclusion criteria, with 1178 patients included in the network meta-analysis. There was a mean weighted age of 62.8 years, 568 (48.2%) men, with a mean follow-up of 28.9 months. There were no significant differences between groups in regard to sex (P = .732) or age (P = .469). For the ASES score, InSpace balloon arthroplasty (mean difference [MD], 12.34; 95% CI, 2.18 to 22.50; P = .017), arthroscopic bridging graft (aBG) (MD, 7.07; 95% CI, 0.28 to 13.85; P = .041), and long head of biceps augmented superior capsular reconstruction (BSCR) (MD, 5.16; 95% CI, 1.10 to 9.22; P = .013) resulted in the highest P-scores. For the Constant-Murley score, debridement (MD, 21.03; 95% CI, 8.98 to 33.08; P < .001) and aBG (MD, 6.97; 95% CI, 1.88 to 12.05; P = .007) resulted in the highest P-scores. For AHD, BSCR resulted in the highest P-score (MD, 1.46; 95% CI, 0.45 to 2.48; P = .005). For forward flexion ROM, debridement (MD, 45.77; 95% CI, 25.41 to 66.13; P < .001) resulted in the highest P-score, while RSA resulted in the lowest P-score (MD, –16.70; 95% CI, −31.20 to −2.20; P = .024).
Conclusion:
For patients <70 years with MIRCT without significant arthritis or pseudoparalysis, it appears that graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains, while RSA provides the least benefit in forward flexion.</description><identifier>ISSN: 0363-5465</identifier><identifier>ISSN: 1552-3365</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/03635465231204623</identifier><identifier>PMID: 38291995</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Arthritis ; Arthroscopy - methods ; Comparative studies ; Debridement ; Humans ; Joint surgery ; Meta-analysis ; Middle Aged ; Network Meta-Analysis ; Patient Reported Outcome Measures ; Range of Motion, Articular ; Rotator cuff ; Rotator Cuff Injuries - surgery ; Systematic review</subject><ispartof>The American journal of sports medicine, 2024-09, Vol.52 (11), p.2919-2930</ispartof><rights>2024 The Author(s)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-d6542d388e9b700e200503ccab2ccf269f0a66977c47c553256e56162435fae43</citedby><cites>FETCH-LOGICAL-c368t-d6542d388e9b700e200503ccab2ccf269f0a66977c47c553256e56162435fae43</cites><orcidid>0000-0003-3412-7272 ; 0000-0002-1703-6232 ; 0000-0003-1807-1926</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/03635465231204623$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/03635465231204623$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,777,781,21800,27905,27906,43602,43603</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38291995$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bi, Andrew S.</creatorcontrib><creatorcontrib>Anil, Utkarsh</creatorcontrib><creatorcontrib>Colasanti, Christopher A.</creatorcontrib><creatorcontrib>Kwon, Young W.</creatorcontrib><creatorcontrib>Virk, Mandeep S.</creatorcontrib><creatorcontrib>Zuckerman, Joseph D.</creatorcontrib><creatorcontrib>Rokito, Andrew S.</creatorcontrib><title>Comparison of Multiple Surgical Treatments for Massive Irreparable Rotator Cuff Tears in Patients Younger Than 70 Years of Age: A Systematic Review and Network Meta-analysis</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background:
Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis.
Purpose:
To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients <70 years of age for several patient-reported outcomes, range of motion (ROM), and acromiohumeral distance (AHD).
Study Design:
Network meta-analysis of comparative studies; Level of evidence, 3.
Methods:
A systematic review of the literature, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the MEDLINE, Embase, and Cochrane Library databases was conducted from 2017 to 2022. Inclusion criteria were (1) clinical comparative studies of MIRCTs (with several study-specific criteria); (2) ≥1 outcome of interest reported on, with standard deviations; (3) minimum 1-year follow-up; and (4) mean age of <70 years for both cohorts, without arthritis or pseudoparalysis. There were 8 treatment arms compared. Outcomes of interest were the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, visual analog scale for pain, AHD, and forward flexion and external rotation ROM. A frequentist approach to network meta-analysis with a random-effects model was performed using the netmeta package Version 0.9-6 in R.
Results:
A total of 23 studies met the inclusion criteria, with 1178 patients included in the network meta-analysis. There was a mean weighted age of 62.8 years, 568 (48.2%) men, with a mean follow-up of 28.9 months. There were no significant differences between groups in regard to sex (P = .732) or age (P = .469). For the ASES score, InSpace balloon arthroplasty (mean difference [MD], 12.34; 95% CI, 2.18 to 22.50; P = .017), arthroscopic bridging graft (aBG) (MD, 7.07; 95% CI, 0.28 to 13.85; P = .041), and long head of biceps augmented superior capsular reconstruction (BSCR) (MD, 5.16; 95% CI, 1.10 to 9.22; P = .013) resulted in the highest P-scores. For the Constant-Murley score, debridement (MD, 21.03; 95% CI, 8.98 to 33.08; P < .001) and aBG (MD, 6.97; 95% CI, 1.88 to 12.05; P = .007) resulted in the highest P-scores. For AHD, BSCR resulted in the highest P-score (MD, 1.46; 95% CI, 0.45 to 2.48; P = .005). For forward flexion ROM, debridement (MD, 45.77; 95% CI, 25.41 to 66.13; P < .001) resulted in the highest P-score, while RSA resulted in the lowest P-score (MD, –16.70; 95% CI, −31.20 to −2.20; P = .024).
Conclusion:
For patients <70 years with MIRCT without significant arthritis or pseudoparalysis, it appears that graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains, while RSA provides the least benefit in forward flexion.</description><subject>Aged</subject><subject>Arthritis</subject><subject>Arthroscopy - methods</subject><subject>Comparative studies</subject><subject>Debridement</subject><subject>Humans</subject><subject>Joint surgery</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Network Meta-Analysis</subject><subject>Patient Reported Outcome Measures</subject><subject>Range of Motion, Articular</subject><subject>Rotator cuff</subject><subject>Rotator Cuff Injuries - surgery</subject><subject>Systematic review</subject><issn>0363-5465</issn><issn>1552-3365</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10c9uEzEQBnALUdHQ8gBckCUuXLb4z9re5RZFQCs1BbXpoafVxJkNLrvrYHtb5aH6jjhNAQnEyYf5fTOWPkJec3bCuTHvmdRSlVoJyQUrtZDPyIQrJQoptXpOJrt5sQOH5GWMt4wxbnT1ghzKStS8rtWEPMx8v4Hgoh-ob-l87JLbdEivxrB2Fjq6CAipxyFF2vpA5xCju0N6FgLmHCyzvfQJUp7NxralC4QQqRvoV0juMXbjx2GNgS6-wUANozePIh-brvEDndKrbUzYZ23pJd45vKcwrOgFpnsfvtM5JihggG4bXTwmBy10EV89vUfk-tPHxey0OP_y-Ww2PS-s1FUqVlqVYiWrCuulYQwFY4pJa2EprG2FrlsGWtfG2NJYpaRQGpXmWpRStYClPCLv9ns3wf8YMaamd9Fi18GAfoyNqAVTRtSmyvTtX_TWjyH_NzaSc651JbnOiu-VDT7GgG2zCa6HsG04a3ZdNv90mTNvnjaPyx5XvxO_ysvgZA8irPHP2f9v_Al70qaj</recordid><startdate>20240901</startdate><enddate>20240901</enddate><creator>Bi, Andrew S.</creator><creator>Anil, Utkarsh</creator><creator>Colasanti, Christopher A.</creator><creator>Kwon, Young W.</creator><creator>Virk, Mandeep S.</creator><creator>Zuckerman, Joseph D.</creator><creator>Rokito, Andrew S.</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3412-7272</orcidid><orcidid>https://orcid.org/0000-0002-1703-6232</orcidid><orcidid>https://orcid.org/0000-0003-1807-1926</orcidid></search><sort><creationdate>20240901</creationdate><title>Comparison of Multiple Surgical Treatments for Massive Irreparable Rotator Cuff Tears in Patients Younger Than 70 Years of Age: A Systematic Review and Network Meta-analysis</title><author>Bi, Andrew S. ; Anil, Utkarsh ; Colasanti, Christopher A. ; Kwon, Young W. ; Virk, Mandeep S. ; Zuckerman, Joseph D. ; Rokito, Andrew S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-d6542d388e9b700e200503ccab2ccf269f0a66977c47c553256e56162435fae43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Arthritis</topic><topic>Arthroscopy - methods</topic><topic>Comparative studies</topic><topic>Debridement</topic><topic>Humans</topic><topic>Joint surgery</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Network Meta-Analysis</topic><topic>Patient Reported Outcome Measures</topic><topic>Range of Motion, Articular</topic><topic>Rotator cuff</topic><topic>Rotator Cuff Injuries - surgery</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bi, Andrew S.</creatorcontrib><creatorcontrib>Anil, Utkarsh</creatorcontrib><creatorcontrib>Colasanti, Christopher A.</creatorcontrib><creatorcontrib>Kwon, Young W.</creatorcontrib><creatorcontrib>Virk, Mandeep S.</creatorcontrib><creatorcontrib>Zuckerman, Joseph D.</creatorcontrib><creatorcontrib>Rokito, Andrew S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bi, Andrew S.</au><au>Anil, Utkarsh</au><au>Colasanti, Christopher A.</au><au>Kwon, Young W.</au><au>Virk, Mandeep S.</au><au>Zuckerman, Joseph D.</au><au>Rokito, Andrew S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Multiple Surgical Treatments for Massive Irreparable Rotator Cuff Tears in Patients Younger Than 70 Years of Age: A Systematic Review and Network Meta-analysis</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2024-09-01</date><risdate>2024</risdate><volume>52</volume><issue>11</issue><spage>2919</spage><epage>2930</epage><pages>2919-2930</pages><issn>0363-5465</issn><issn>1552-3365</issn><eissn>1552-3365</eissn><abstract>Background:
Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis.
Purpose:
To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients <70 years of age for several patient-reported outcomes, range of motion (ROM), and acromiohumeral distance (AHD).
Study Design:
Network meta-analysis of comparative studies; Level of evidence, 3.
Methods:
A systematic review of the literature, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the MEDLINE, Embase, and Cochrane Library databases was conducted from 2017 to 2022. Inclusion criteria were (1) clinical comparative studies of MIRCTs (with several study-specific criteria); (2) ≥1 outcome of interest reported on, with standard deviations; (3) minimum 1-year follow-up; and (4) mean age of <70 years for both cohorts, without arthritis or pseudoparalysis. There were 8 treatment arms compared. Outcomes of interest were the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, visual analog scale for pain, AHD, and forward flexion and external rotation ROM. A frequentist approach to network meta-analysis with a random-effects model was performed using the netmeta package Version 0.9-6 in R.
Results:
A total of 23 studies met the inclusion criteria, with 1178 patients included in the network meta-analysis. There was a mean weighted age of 62.8 years, 568 (48.2%) men, with a mean follow-up of 28.9 months. There were no significant differences between groups in regard to sex (P = .732) or age (P = .469). For the ASES score, InSpace balloon arthroplasty (mean difference [MD], 12.34; 95% CI, 2.18 to 22.50; P = .017), arthroscopic bridging graft (aBG) (MD, 7.07; 95% CI, 0.28 to 13.85; P = .041), and long head of biceps augmented superior capsular reconstruction (BSCR) (MD, 5.16; 95% CI, 1.10 to 9.22; P = .013) resulted in the highest P-scores. For the Constant-Murley score, debridement (MD, 21.03; 95% CI, 8.98 to 33.08; P < .001) and aBG (MD, 6.97; 95% CI, 1.88 to 12.05; P = .007) resulted in the highest P-scores. For AHD, BSCR resulted in the highest P-score (MD, 1.46; 95% CI, 0.45 to 2.48; P = .005). For forward flexion ROM, debridement (MD, 45.77; 95% CI, 25.41 to 66.13; P < .001) resulted in the highest P-score, while RSA resulted in the lowest P-score (MD, –16.70; 95% CI, −31.20 to −2.20; P = .024).
Conclusion:
For patients <70 years with MIRCT without significant arthritis or pseudoparalysis, it appears that graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains, while RSA provides the least benefit in forward flexion.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>38291995</pmid><doi>10.1177/03635465231204623</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-3412-7272</orcidid><orcidid>https://orcid.org/0000-0002-1703-6232</orcidid><orcidid>https://orcid.org/0000-0003-1807-1926</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0363-5465 |
| ispartof | The American journal of sports medicine, 2024-09, Vol.52 (11), p.2919-2930 |
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| language | eng |
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| source | MEDLINE; SAGE Complete A-Z List; Alma/SFX Local Collection |
| subjects | Aged Arthritis Arthroscopy - methods Comparative studies Debridement Humans Joint surgery Meta-analysis Middle Aged Network Meta-Analysis Patient Reported Outcome Measures Range of Motion, Articular Rotator cuff Rotator Cuff Injuries - surgery Systematic review |
| title | Comparison of Multiple Surgical Treatments for Massive Irreparable Rotator Cuff Tears in Patients Younger Than 70 Years of Age: A Systematic Review and Network Meta-analysis |
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