Update on all-arthroscopic vs. mini-open rotator cuff repair: A systematic review and meta-analysis

Sakha, Seaher; Erdogan, Safiya; Shanmugaraj, Ajaykumar; Betsch, Marcel; Leroux, Timothy; Khan, Moin

doi:10.1016/j.jor.2021.03.009

Cited by 15 publications

(10 citation statements)

References 46 publications

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“…The overall complication rate in our review was 11%. This is lower than the 21% rate in a systematic review by Sakha et al 35 The difference might be a result of varying definitions of complications. In terms of retear rate, pooled analysis in this study revealed that retears occur frequently after a mean follow-up of 14 years and were noted in 41% of shoulders.…”

Section: Discussioncontrasting

confidence: 56%

“…In terms of retear rate, pooled analysis in this study revealed that retears occur frequently after a mean follow-up of 14 years and were noted in 41% of shoulders. A retear rate of 12% was cited in a systematic review with a mean follow-up of 16 months, 35 which is likely associated with the very different follow-up periods. Accordingly, a retear rate of 34% was noted at the 10-year follow-up in a study examining 130 shoulders.…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs

Plachel

Rüttershoff

et al. 2022

Am J Sports Med

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Background: Arthroscopic rotator cuff repair (aRCR) has shown similar midterm functional results and retear rates as open/mini-open rotator cuff repair (oRCR). A pooled analysis of long-term results of both techniques is yet missing. Purpose: To evaluate the long-term results of aRCR and oRCR for full-thickness rotator cuff tears. Study Design: Systematic review; Level of evidence, 4. Methods: The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CENTRAL (Cochrane), MEDLINE (PubMed), and Embase databases were searched for studies that reported on long-term clinical and radiographic outcomes of full-thickness aRCR and oRCR with a minimum follow-up of 9 years. Results: Eleven studies were included: 5 studies on aRCR and 6 studies on oRCR. Studies were based on 550 shoulders (539 patients) with a mean patient age of 56.3 years (range, 25-77). After a mean follow-up of 14.0 years (range, 9-20), the mean preoperative absolute Constant score (CS) and American Shoulder and Elbow Surgeons (ASES) shoulder score were significantly improved postoperatively (CS, 44 to 78 points; ASES, 52% to 91%; both comparisons, P < .001). The retear rate was 41% (141 of 342 shoulders) without a significant difference between groups (aRCR, 43%; oRCR, 39%) ( P = .364). A retear was associated with significantly reduced CS as compared with a healed repair ( P = .004). No significant differences were found in postoperative functional scores, complications, and retear rates after failed cuff repairs between the arthroscopic and open/mini-open repair groups. Conclusion: Pooled analysis of arthroscopic and open rotator cuff repairs demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. There were no significant differences in long-term functional outcomes, retear rates, and complications. Both surgical techniques may be used on the basis of factors such as patient or surgeon preference and cost. Further studies using a more robust randomized controlled trial or larger cohort design are recommended to ascertain whether one surgical repair technique is superior to the other. Registration: CRD42020180448 (PROSPERO).

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs

Plachel

Rüttershoff

et al. 2022

Am J Sports Med

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“…3 However, retear rates range from 10 to 43%, 4,5 and there are no differences in retear rates for open or arthroscopic surgery. 6 Preoperative tear size and retraction are the main reported risk factors for poorer clinical outcomes and retear rates. 7 Not surprisingly, shoulder surgeons have explored whether augmentation of cuff repair would not only result in better cuff integrity but also reduce retear rates.…”

Section: See Related Article On Page 38mentioning

confidence: 99%

Editorial Commentary: Long Head Biceps Tendon Can Be Used Like a Split Skin Graft: Mesh It and Augment Rotator Cuff Repairs

Hohmann¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Full-thickness tears of the rotator cuff are common, and surgical treatment is indicated in most cases. Arthroscopic repair has become the standard technique, but despite improved surgical techniques, instrumentations, and implants, failure rates continue to be high and can reach 40% and more. Augmented repairs with allograft patches or autograft tissue, such as long head biceps tendon or fascia lata, have been used with mixed results. However, autograft augmentation seems to be resulting in superior outcomes and higher healing rates. Treating skin defects with split-skin grafts is the gold standard in burns and soft-tissue surgery. Given the limited supply of autograft, meshing autograft tendon and using it similar to a split-skin graft is a novel idea. When using a 2:1 expansion ratio, the long head biceps tendon can be formed into a porous scaffold with the in situ tenocytes, producing cytokines and promoting tenogenic differentiation. However, the scaffolds exhibited reduced tensile properties. The results are encouraging, and it will be interesting whether the clinical trials will demonstrate higher healing rates and better functional outcomes when compared to primary repair and allograft patch augmentation.

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“…Rotator cuff repairs are one of the most common surgical procedures done by an orthopedic surgeon, especially in the older population. Nearly 21% of the general population will have a rotator cuff injury, from traumatic or degenerative causes, in their lifetime [1]. Rotator cuff tears do not always end up with surgical inter-How to cite this paper: Harwood, K., Hubler, Z. and Cappola III, J.…”

Section: Introductionmentioning

confidence: 99%

Clinical Decision Making in Open vs Arthroscopic Rotator Cuff Repair: Evidence for Preoperative Decision Making

Harwood¹,

Hubler²,

Cappola³

2022

OJO

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Objective: To further understand what factors should be considered when deciding to do mini-open versus arthroscopic rotator cuff repair. Methods: A systematic literature search on the computer was done with the help of the PubMed database. Of the articles searched through, three have been chosen to specifically address topics of interest concerning the factors affecting arthroscopic vs mini-open RCR surgical approaches. Discussion: As we continue to progress down the line of factors impacting a clinician's decision making, we begin to see how postoperative management is unchanged. Tear severity lacks sufficient evidence to base a decision on, but financial, educational, and logistical factors are proven to play a significant role in this decision. Conclusion: As of right now it seems that mini-open RCR is the most cost and time efficient method, especially amongst non-fellowship trained surgeons or ones with lower volume of shoulder scopes. However, further studies should be done to examine cost and efficiency in Sport Medicine fellowship trained orthopedic surgeons to validate these findings.

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Update on all-arthroscopic vs. mini-open rotator cuff repair: A systematic review and meta-analysis

Cited by 15 publications

References 46 publications

A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs

A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs

Editorial Commentary: Long Head Biceps Tendon Can Be Used Like a Split Skin Graft: Mesh It and Augment Rotator Cuff Repairs

Clinical Decision Making in Open vs Arthroscopic Rotator Cuff Repair: Evidence for Preoperative Decision Making

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