Surgical repair of large-to-massive rotator cuff tears seems to be a better option than patch augmentation or débridement and biceps tenotomy: a prospective comparative study

Maillot, Cédric; Harly, Édouard; Demezon, Hugues; Huec, Jean-Charles Le

doi:10.1016/j.jse.2018.05.023

Cited by 33 publications

(50 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For the non-randomised comparative studies, only three reported a significant improvement in functional shoulder scores for synthetic, 30 human allograft 40 and fascia lata autografts. 13 The remaining studies found no significant improvement, 31 34 41–45 while the studies by Ito et al , 42 Veen et al 32 and Vitali et al 46 did not undertake intergroup comparisons.…”

Section: Resultsmentioning

confidence: 97%

Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

ObjectiveTo appraise studies reporting on clinical effectiveness and safety of surgical meshes used to augment rotator cuff repairs (RCRs).DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase and Cochrane databases were searched between April 2006 and April 2020.Eligibility criteriaAll studies evaluating adults (≥18 years) undergoing RCR were considered. There were no language restrictions.Data extraction and synthesisScreening, data extraction and quality appraisal were conducted by two independent reviewers. Meta-analysis was conducted using a random-effects models if ≥2 comparative studies reported the same outcome measure. Risk of bias assessment was undertaken for randomised (RoB2, Cochrane) and comparative studies (ROBINS-I, Cochrane).ResultsWe included 60 studies, consisting of 7 randomised controlled trials, 13 observational comparative studies and 40 observational case series. All comparative studies reported on shoulder-specific functional outcome scores, 18 on the radiographic occurrence of re-tear and 14 on pain score metrics. All studies contained some risk of bias.Compared with non-augmented repair, a small improvement in shoulder-specific function or pain scores was observed for synthetic patches with a mean improvement of 6.7 points on the University of California Los Angles (UCLA) shoulder score (95% CI 0.1 to 13.4) and 0.46 point reduction on the Visual Analogue Scale (95% CI −0.74 to −0.17), respectively. A reduced likelihood of radiologically observed re-tear was observed for synthetic (risk ratio (RR) 0.41, 95% CI 0.27 to 0.61) and allograft (RR 0.34, 95% CI 0.18 to 0.65) patches. A total of 49 studies reported on the occurrence of complications. Slightly higher crude complication rates were observed following patch-augmented repair (2.1%) than standard repair (1.6%).ConclusionsWhile several studies suggest a decreased failure rate and small improvements in shoulder function and pain following augmented RCR, a paucity of rigorous clinical evaluation, for both effectiveness and safety, prevents firm recommendations.Prospero registration numberCRD42017057908.

show abstract

Section: Resultsmentioning

confidence: 97%

Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Most comparative studies assessed a single patch against standard repair, with some studies having up to three treatment arms. 40,63,64 Across all the comparative studies a total of 12 different patches were utilised. Study population sizes ranged from 30 to 89 patients (age range 29-82 years) for RCTs and from 21 to 152 patients (age range 36-83 years) for observational comparative studies, with a predominance of male participants across all studies.…”

Section: Comparative Studiesmentioning

confidence: 99%

Patch augmentation surgery for rotator cuff repair: the PARCS mixed-methods feasibility study

Cook

Baldwin

Cooper

et al. 2021

Health Technol Assess

View full text Add to dashboard Cite

Background A rotator cuff tear is a common, disabling shoulder problem. Symptoms may include pain, weakness, lack of shoulder mobility and sleep disturbance. Many patients require surgery to repair the tear; however, there is a high failure rate. There is a need to improve the outcome of rotator cuff surgery, and the use of patch augmentation (on-lay or bridging) to provide support to the healing process and improve patient outcomes holds promise. Patches have been made using different materials (e.g. human/animal skin or tissue and synthetic materials) and processes (e.g. woven or mesh). Objectives The aim of the Patch Augmented Rotator Cuff Surgery (PARCS) feasibility study was to determine the design of a definitive randomised controlled trial assessing the clinical effectiveness and cost-effectiveness of a patch to augment surgical repair of the rotator cuff that is both acceptable to stakeholders and feasible. Design A mixed-methods feasibility study of a randomised controlled trial. Data sources MEDLINE, EMBASE and the Cochrane Library databases were searched between April 2006 and August 2018. Methods The project involved six stages: a systematic review of clinical evidence, a survey of the British Elbow and Shoulder Society’s surgical membership, a survey of surgeon triallists, focus groups and interviews with stakeholders, a two-round Delphi study administered via online questionnaires and a 2-day consensus meeting. The various stakeholders (including patients, surgeons and industry representatives) were involved in stages 2–6. Results The systematic review comprised 52 studies; only 15 were comparative and, of these, 11 were observational (search conducted in August 2018). These studies were typically small (median number of participants 26, range 5–152 participants). There was some evidence to support the use of patches, although most comparative studies were at a serious risk of bias. Little to no published clinical evidence was available for a number of patches in clinical use. The membership survey of British Elbow and Shoulder surgeons [105 (21%) responses received] identified a variety of patches in use. Twenty-four surgeons (77%) completed the triallist survey relating to trial design. Four focus groups were conducted, involving 24 stakeholders. Differing views were held on a number of aspects of trial design, including the appropriate patient population (e.g. patient age) to participate. Agreement on the key research questions and the outline of two potential randomised controlled trials were achieved through the Delphi study [29 (67%)] and the consensus meeting that 22 participants attended. Limitations The main limitation was that the findings were influenced by the participants, who are not necessarily representative of the views of the relevant stakeholder groups. Conclusion The need for further clinical studies was clear, particularly given the range and number of different patches available. Future work Randomised comparisons of on-lay patch use for completed rotator cuff repairs and bridging patch use for partial rotator cuff repairs were identified as areas for further research. The value of an observational study to assess safety concerns of patch use was also highlighted. These elements are included in the trial designs proposed in this study. Study registration The systematic review is registered as PROSPERO CRD42017057908. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 13. See the NIHR Journals Library website for further project information.

show abstract

“…Studies comparing these different treatment options are scarce or have methodologic weaknesses such as a small study group or a nonrandomized study group allocation. 20 Furthermore, not all shoulder surgeons are familiar with all these techniques, and long-term results of newer methods are absent.…”

Section: See Related Article On Page 2080mentioning

confidence: 99%

Editorial Commentary: Rotator Cuff Tear: Know When Not to Operate So You Don't Make It Worse

Heerspink

Dorrestijn²

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

Shoulder rotator cuff repair results in significantly improved outcomes compared with conservative treatment, but some repairs result in retear and, worst of all, enlarged retears (i.e., tears larger after surgery than primarily). Elevated serum total cholesterol and low-density lipoprotein levels and fatty infiltration of the infraspinatus are significantly related to symptomatic failed rotator cuff repair. Hypertension could also be a risk factor. In such cases, nonoperative treatment, reverse shoulder prosthesis (in older patients), or alternative joint-preserving procedures (superior capsular reconstruction, subacromial balloon spacer, multiple-tendon interposition autografts, augmentation of the long head of the biceps, or tendon transfers such as latissimus dorsi transfer and lower trapezius transfer) could be considered or are worthy of future investigation.

show abstract

Surgical repair of large-to-massive rotator cuff tears seems to be a better option than patch augmentation or débridement and biceps tenotomy: a prospective comparative study

Cited by 33 publications

References 32 publications

Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

Patch augmentation surgery for rotator cuff repair: the PARCS mixed-methods feasibility study

Editorial Commentary: Rotator Cuff Tear: Know When Not to Operate So You Don't Make It Worse

Contact Info

Product

Resources

About