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Arthroscopic Rotator Cuff Repair

A Systematic Review of Overlapping Meta-Analyses

Hurley, Eoghan T., MB, BCh1,2; Maye, Andrew B., MB BCh1,2; Mullett, Hannan, MCh, FRSCI(Tr&Orth)1

doi: 10.2106/JBJS.RVW.18.00027
Evidence-Based Systematic Reviews
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Disclosures

Background: Rotator cuff tears are a common pathology, with an increasing number of repairs being performed arthroscopically. The purpose of this study was to systematically review the results in the current meta-analyses on arthroscopic rotator cuff repair, looking specifically at double-row repair compared with single-row repair, at whether platelet-rich plasma should be used adjunctively at the time of the surgical procedure, and at the effects of early-motion compared with late-motion rehabilitation postoperatively.

Methods: MEDLINE, Embase, and the Cochrane Library were screened for meta-analyses on arthroscopic rotator cuff repair. The levels and quality of the evidence were assessed, and the clinical outcomes were evaluated. A significant result was defined as p < 0.05.

Results: Twenty-four meta-analyses were identified, with 10 meta-analyses on double-row repair compared with single-row repair, 7 meta-analyses on platelet-rich plasma compared with a control, and 7 meta-analyses on early motion compared with late motion. Studies found a significant result in terms of reduced retear rates and/or increased tendon-healing rate for double-row repair (6 of 10 studies; p < 0.05), without a clinically important improvement in functional outcomes (0 of 10 studies). There was a favorable outcome when using platelet-rich plasma in small-to-medium tears in terms of a reduced rate of retear (4 of 4 studies; p < 0.05). However, in the 1 study in which platelet-rich plasma was stratified into pure platelet-rich plasma and platelet-rich fibrin matrix preparation, there was a significantly lower retear rate for tears of all sizes with platelet-rich plasma and not with platelet-rich fibrin (p < 0.05). Range of motion was shown to be significantly better with early motion (5 of 6 studies; p < 0.05) in the majority of the meta-analyses, without an increased risk of retear (6 of 6 studies; p > 0.05).

Conclusions: The highest Level of Evidence and the highest-quality studies all supported the use of double-row repair, adjunctive platelet-rich plasma, and early-motion rehabilitation postoperatively in arthroscopic rotator cuff repair.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Sports Surgery Clinic, Dublin, Ireland

2Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland

E-mail address for E.T. Hurley: eoghanhurley@rcsi.ie

Investigation performed at the Sports Surgery Clinic, Dublin, Ireland

Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A454).

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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