Randy Mascarenhas1, Peter N Chalmers2, Eli T Sayegh3, Mohit Bhandari4, Nikhil N Verma2, Brian J Cole2, Anthony A Romeo2. 1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: mascarer@hotmail.com. 2. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A. 3. College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A. 4. Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
Abstract
PURPOSE: Multiple meta-analyses of randomized clinical trials, the highest available level of evidence, have been conducted to determine whether double-row (DR) or single-row (SR) rotator cuff repair (RCR) provides superior clinical outcomes and structural healing; however, results are discordant. The purpose of this study was to conduct a systematic review of meta-analyses comparing SR and DR RCR to elucidate the cause of discordance and to determine which meta-analysis provides the current best available evidence. METHODS: In this study we evaluated available scientific support for SR versus DR RCR by systematically reviewing the literature for published meta-analyses. Data were extracted from these meta-analyses for patient outcomes and structural healing. Meta-analysis quality was assessed with the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad algorithm was then applied to determine which meta-analyses provided the highest level of evidence. RESULTS: Eight meta-analyses met the eligibility criteria: 4 including Level I evidence and 4 including both Level I and Level II evidence. Six meta-analyses found no differences between SR and DR RCR for patient outcomes, whereas 2 favored DR RCR for tears greater than 3 cm. Two meta-analyses found no structural healing differences between SR and DR RCR, whereas 3 found DR repair to be superior for tears greater than 3 cm and 2 found DR repair to be superior for all tears. Four meta-analyses had low Oxman-Guyatt scores (<3) indicative of major flaws. After application of the Jadad algorithm, 3 concordant high-quality meta-analyses were selected, all of which found significantly better structural healing with DR compared with SR RCR. CONCLUSIONS: According to this systematic review of overlapping meta-analyses comparing SR and DR RCR, the current highest level of evidence suggests that DR RCR provides superior structural healing to SR RCR. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.
PURPOSE: Multiple meta-analyses of randomized clinical trials, the highest available level of evidence, have been conducted to determine whether double-row (DR) or single-row (SR) rotator cuff repair (RCR) provides superior clinical outcomes and structural healing; however, results are discordant. The purpose of this study was to conduct a systematic review of meta-analyses comparing SR and DR RCR to elucidate the cause of discordance and to determine which meta-analysis provides the current best available evidence. METHODS: In this study we evaluated available scientific support for SR versus DR RCR by systematically reviewing the literature for published meta-analyses. Data were extracted from these meta-analyses for patient outcomes and structural healing. Meta-analysis quality was assessed with the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad algorithm was then applied to determine which meta-analyses provided the highest level of evidence. RESULTS: Eight meta-analyses met the eligibility criteria: 4 including Level I evidence and 4 including both Level I and Level II evidence. Six meta-analyses found no differences between SR and DR RCR for patient outcomes, whereas 2 favored DR RCR for tears greater than 3 cm. Two meta-analyses found no structural healing differences between SR and DR RCR, whereas 3 found DR repair to be superior for tears greater than 3 cm and 2 found DR repair to be superior for all tears. Four meta-analyses had low Oxman-Guyatt scores (<3) indicative of major flaws. After application of the Jadad algorithm, 3 concordant high-quality meta-analyses were selected, all of which found significantly better structural healing with DR compared with SR RCR. CONCLUSIONS: According to this systematic review of overlapping meta-analyses comparing SR and DR RCR, the current highest level of evidence suggests that DR RCR provides superior structural healing to SR RCR. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.
Authors: Mina Abdelshahed; Siddharth A Mahure; Daniel J Kaplan; Brent Mollon; Joseph D Zuckerman; Young W Kwon; Andrew S Rokito Journal: Arthrosc Tech Date: 2016-11-14