Andreas M Müller1,2, Matthias Flury3, Hasan N Alsayed2,4, Laurent Audigé5,6. 1. Research and Development, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland. 2. Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland. 3. Upper Extremities, Schulthess Clinic, Zurich, Switzerland. 4. Department of Orthopaedics, Dammam University, Dammam, Saudi Arabia. 5. Research and Development, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland. Laurent.Audige@kws.ch. 6. Upper Extremities, Schulthess Clinic, Zurich, Switzerland. Laurent.Audige@kws.ch.
Abstract
PURPOSE: The purpose of this meta-analysis was to investigate patient and diagnostic parameters influencing the reported rates of recurrent rotator cuff defects after ARCR. METHODS: PubMed, EMBASE, Cochrane Library and Scopus databases were searched for clinical studies on tendon defects after ARCR. Imaging modalities, definitions, detection time points, and other known patient risk factors (patient age, tear severity, grade of fatty infiltration, repair technique) as well as reported defect rates were extracted. A meta-analysis of proportion and meta-regression analysis were used to investigate independent variables influencing reported defect rates. RESULTS: Of 109 articles reviewed, the diagnostic studies used magnetic resonance imaging (MRI) only (n = 56), ultrasound (US) only (n = 28), MRI or computed tomography (CT) arthrography (CTA, n = 14) or a combination of US, MRI and CTA (n = 11) up to 57 months after ARCR. Definitions of tendon defects were highly variable, including those of partial tendon healing with insufficient thickness defined as either an acceptable outcome (n = 72) or a recurrent defect (n = 22). Reported defect rates demonstrated highly significant heterogeneity between studies and groups. Follow-up time and the evaluation of partial tendon healing were independent factors of the defect rate alongside age, tear severity and repair technique. The type of imaging did not significantly alter defect rates. CONCLUSION: A number of specific factors significantly alter the rates of rotator cuff defects reported after ARCR. Standardized protocols in clinical practice are required for consistent diagnosis of recurrent defects after ARCR. LEVEL OF EVIDENCE: IV.
PURPOSE: The purpose of this meta-analysis was to investigate patient and diagnostic parameters influencing the reported rates of recurrent rotator cuff defects after ARCR. METHODS: PubMed, EMBASE, Cochrane Library and Scopus databases were searched for clinical studies on tendon defects after ARCR. Imaging modalities, definitions, detection time points, and other known patient risk factors (patient age, tear severity, grade of fatty infiltration, repair technique) as well as reported defect rates were extracted. A meta-analysis of proportion and meta-regression analysis were used to investigate independent variables influencing reported defect rates. RESULTS: Of 109 articles reviewed, the diagnostic studies used magnetic resonance imaging (MRI) only (n = 56), ultrasound (US) only (n = 28), MRI or computed tomography (CT) arthrography (CTA, n = 14) or a combination of US, MRI and CTA (n = 11) up to 57 months after ARCR. Definitions of tendon defects were highly variable, including those of partial tendon healing with insufficient thickness defined as either an acceptable outcome (n = 72) or a recurrent defect (n = 22). Reported defect rates demonstrated highly significant heterogeneity between studies and groups. Follow-up time and the evaluation of partial tendon healing were independent factors of the defect rate alongside age, tear severity and repair technique. The type of imaging did not significantly alter defect rates. CONCLUSION: A number of specific factors significantly alter the rates of rotator cuff defects reported after ARCR. Standardized protocols in clinical practice are required for consistent diagnosis of recurrent defects after ARCR. LEVEL OF EVIDENCE: IV.
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Authors: Laurent Audigé; Heiner C C Bucher; Soheila Aghlmandi; Thomas Stojanov; David Schwappach; Sabina Hunziker; Christian Candrian; Gregory Cunningham; Holger Durchholz; Karim Eid; Matthias Flury; Bernhard Jost; Alexandre Lädermann; Beat Kaspar Moor; Philipp Moroder; Claudio Rosso; Michael Schär; Markus Scheibel; Christophe Spormann; Thomas Suter; Karl Wieser; Matthias Zumstein; Andreas M Müller Journal: BMJ Open Date: 2021-04-22 Impact factor: 2.692
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