Single-row versus double-row suture in rotator cuff repair: a meta-analysis

doi:10.3969/j.issn.2095-4344.2014.29.026

Abstract

Abstract:

BACKGROUND: Single-row and double-row suture method are commonly used in the rotator cuff repair. Previous studies have shown that, double-row suture is not better than single-row suture in clinics.

OBJECTIVE: To compare clinical outcomes of single-row suture and double-row suture for rotator cuff repair, and evaluate the difference of therapeutic efficacy between two methods.

METHODS: A computer-based search was performed in the Medline (from January 2003 to February 2014), EMBASE (from January 2003 to February 2014) and Cochrane library (February 2014). According to the inclusion and exclusion criteria, all the randomized controlled studies addressing the outcome of single-row repair and double-row repair techniques were included in this meta-analysis. The methodological quality of each study was judged and a meta-analysis was conducted using Revman5.0. The preoperative and postoperative differences between the Constant score, American Shoulder and Elbow Surgeons (ASES) score,
University of California, Los Angeles (UCLA) score, the re-rupture rate and the muscle strength were compared. The forest chart was used to compare the data between two groups, and the funnel plot was finished to detect the publication bias.

RESULTS AND CONCLUSION: A total of 10 randomized controlled trials (Levels I, II) were included. Meta-analysis showed that, there was no statistically significant difference in the Constant, ASES and UCLA scores in the double-row group and the single-row group before and after treatment. In the postoperative follow-up, double-row group had a lower re-rupture rate and a higher abductor muscle strength than single-row group. When the rotator cuff tear was less than

3 cm, double-row group had no significant difference with the single-row suture group. While in the over 3-cm tear group, double-row group showed better results than the single-row suture group on the Constant scpre, ASES score and UCLA score. Double-row suture has a low re-rupture rate than single-row suture in rotator cuff injury, and could achieve better abduction muscle strength. There is no significant difference in the functional score between double-row suture and single-row suture in the rotator cuff tear of less than 3 cm, while in the over 3-cm tear, double-row suture could achieve better functional score.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: shoulder, lacerations, suture techniques

CLC Number:

R318

Zhuang Ze, Lu Hua-ding, Chen Yu-xian, Peng You, Ren Jian-hua, Wang Kun . Single-row versus double-row suture in rotator cuff repair: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(29): 4742-4751.

Figures/Tables 6

2.3 Meta分析结果对数据进行4种分类比较：①总的肩袖损伤患者各类评分比较。②总的肩袖损伤患者外科治疗后再断裂率比较。③肩袖撕裂>3和<3 cm亚组分类的各类评分比较。④肩袖撕裂>3和<3 cm亚组分类的肩关节肌力指数(SSI)比较。 2.3.1 总的肩袖损伤患者治疗前后各类评分比较的Meta分析 10项研究在单双排组间的年龄，性别，肩袖脂肪浸润，随访时间上未见明显统计学差异，其中7个使用constant评分，4个使用AESE评分，3个使用UCLA评分进行评估。 constant评分比较结果：各研究间有统计学异质性(I2=81%)，采用随机效应模型进行分析，外科治疗后单双排评分差异无显著性意义(WMD=1.55，95%CI：-1.57-4.67，P=0.33)。 UCLA评分比较：各研究间有统计学异质性(I2=71%)，采用随机效应模型进行分析，外科治疗后单双排评分差异无显著性意义(WMD=-0.40，95%CI：-1.92-1.1，P=0.60)。 ASES评分比较：各研究间异质性情况有统计学异质性(I2=54%)，采用随机效应模型进行分析。外科治疗后单双排评分差异无显著性意义(WMD=-1.41，95%CI：-3.22-0.39，P=0.12)。结果见图2-4。 2.3.2 各研究随访肩袖再断裂率Meta分析 10项研究中有6个报导了外科治疗后的肩袖再断裂情况，评价方法主要是采用MRI复查了解术后肩袖愈合情况。各研究间无统计学异质性(I2=0%)，采用固定效应模型进行分析。结果显示外科治疗后单双排肩袖再断裂率间有显著性意义(RR=1.72，95%CI：1.23-2.41，P=0.002)。结果见图5。 2.3.3 按撕裂大小行亚组分析的Meta分析结果肩袖撕裂<3 cm亚组的各评分比较情况：外科治疗后constant评分比较：各研究间无统计学异质性(I2=0%)，采用固定效应模型进行分析，外科治疗后单双排评分差异无显著性意义(WMD=0.06，95%CI：-1.36-1.48，P=0.93)。外科治疗后ASES评分比较：各研究间无统计学异质性(I2=0%)，采用固定效应模型进行分析，外科治疗后单双排评分差异无显著性意义(WMD=-0.3，95%CI：-1.37-0.77，P=0.58)。外科治疗后UCLA评分比较：各研究间无统计学异质性(I2=0%)，采用固定效应模型进行分析，外科治疗后单双排评分差异无显著性意义(WMD=-0.45，95%CI：-1.04-0.14，P=0.14)。结果见图6-8。肩袖撕裂>3 cm亚组的评分比较情况：外科治疗后constant评分比较：各研究间有统计学异质性(I2=93%)，采用随机效应模型进行分析，外科治疗后单双排评分差异无显著性意义(WMD=-4.69，95%CI：-10.52-1.14，P=0.11)。外科治疗后ASES评分比较：各研究间无统计学异质性(I2=0%)，采用固定效应模型进行分析，外科治疗后单双排评分差异有显著性意义(WMD=-3.23，95%CI：-4.31-2.15，P < 0.01)。外科治疗后UCLA评分比较：各研究间无统计学异质性(I2=11%)，采用固定效应模型进行分析，外科治疗后单双排评分差异有显著性意义 (WMD=-1.06，95%CI：-1.52--0.61，P=0.33)。结果见图9-11。 2.3.4 肩关节肌力指数(Shoulder Strength Index，SSI) Meta分析结果 10项研究中有6个报导了外科治疗后的肩关节肌力恢复情况。评价的方法有绝对肌力的比较和相对肌力的比较，鉴于患者的个体化肩袖损伤情况不同，采用每个患者的患肩肌力对比健肩肌力的比值结果更具有参考性，作者只对采用肩关节肌力指数比较的研究进行分析。肩袖撕裂<3 cm组：在外展肌力方面，各研究间无统计学异质性(I2=0%)，采用固定效应模型进行分析，结果显示外科治疗后评分差异有显著性意义(WMD=-0.02，95%CI：-0.03-0.00，P=0.01)。在内旋肌力方面，各研究间无明显统计学异质性(I2=0%)，采用固定效应模型进行分析，结果显示外科治疗后评分差异有显著性意义 (WMD=-0.02，95%CI：-0.03至-0.01，P=0.005)。在外旋肌力方面，各研究间有统计学异质性(I2=88%)，采用随机效应模型进行分析，结果显示外科治疗后评分差异无显著性意义(WMD=0.03，95%CI：-0.06至-0.12，P=0.5)。结果见图12-14。肩袖撕裂>3 cm组：在外展肌力方面，各研究间有统计学异质性(I2=89%)，采用随机效应模型进行分析，结果显示外科治疗后评分差异有显著性意义(WMD=-0.02，95%CI：-0.04至-0.01，P < 0.01)。在内旋肌力方面，各研究间有统计学异质性(I2=66%)，采用随机效应模型进行分析，结果显示外科治疗后评分差异无显著性意义(MD=-0.04，95%CI：-0.1-0.02，P=0.16)。在外旋肌力方面，各研究间无统计学异质性(P=0.6，I2=0%)，采用固定效应模型进行分析，结果显示外科治疗后评分差异有显著性意义(WMD=-0.05，95%CI：-0.08-0.02，P < 0.01)。结果见图15-17。综合以上情况分析，外展肌力在>3 cm组和<3 cm组结论都支持双排缝合组术后外展肌力优于单排缝合组。 2.3.5 发表偏倚情况对进行肩袖再断裂随访的研究行漏斗图分析，以RR值为横坐标，SE(logRR)为纵坐标绘制漏斗图，所有点大部分都位于两虚线所围成的范围内，且基本对称分布于OR合并线的两侧，呈倒“漏斗状”，图形基本对称，作者认为在肩袖再断裂率的Meta研究纳入文献的发表性偏倚不大。结果见图18。"

References

[1] Liem D, Bartl C, Lichtenberg S, et al.Clinical outcome and tendon integrity of arthroscopic versus mini-open supraspinatus tendon repair: A magnetic resonance imaging-controlled matched-pair analysis. Arthroscopy. 2007; 23:514-521.

[2] Smith CD, Alexander S, Hill AM, et al.A biomechanical comparison of single and double-row ?xation in arthroscopic rotator cuff repair.J Bone Joint Surg Am. 2006;88:2425-2431.

[3] Milano G, Grasso A, Zarelli D,et al.Comparison between single-row and double-row rotator cuff repair: A biomechanical study. Knee Surg Sports Traumatol Arthrosc.2008;16:75-80.

[4] Park JY, Lhee SH, Choi JH,et al.Comparison of the clinical outcomes of single- and double-row repairs in rotator cuff tears. Am J Sports Med.2008;36:1310-1316.

[5] Sugaya H, Maeda K, Matsuki K,et al. Functional and structural outcome after arthroscopic full-thickness rotator cuffrepair: Single-row versus dual-row ?xation. Arthroscopy. 2005;21:1307-1316.

[6] Grasso A, Milano G, Salvatore M,et al. Single-row versus double-row arthroscopic rotator cuff repair: A prospective randomized clinical study.Arthroscopy. 2009;25:4-12.

[7] Jadad AR, Moore RA, Corral D. Assessing the quality of the reports of randomized clinical trials: is blinding necessary? Control Clin Trials.1996;17(1):1-12.

[8] Constant CR, Murley AH.A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987: 160-164.

[9] Michener LA,McClure PW,Sennett BJ.American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and respon-siveness. J Shoulder Elbow Surg.2002;11:587-594.

[10] Franceschi F, Ruzzini L, Longo UG, et al. Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: A randomized controlled trial. Am J Sports Med 2007;35:1254-1260.

[11] Charousset C, Grimberg J, Duranthon LD,et al.Can a double-row anchorage technique improve tendonhealing in arthroscopic rotator cuff repair? A prospective non randomized, comparative study of double-row and single-row anchorage techniques with computed tomographic arthrography tendon healing assessment. Am J Sports Med. 2007;35:1247-1253.

[12] Burks RT, Crim J, Brown N,et al.A prospectiver and randomized clinical trial comparing arthroscopic single-and double-row rotator cuff repair. Am J Sports Med. 2009;37:647-683.

[13] Koh KH, Kang KC, Lim TK,et al. Prospective randomized clinical trial of single- versus double-row suture anchor repair in 2-to 4-cm rotator cuff tears: clinical and magnetic resonance imaging results. Arthroscopy.2011;27:453-462.

[14] Ma HL, Chiang ER, Wu HT,et al.Clinical outcome and imaging of arthroscopic single-row and double row rotator cuff repair: a prospective randomized trial. Arthroscopy.2012;28:16-24.

[15] Carbonel I, Martinez AA, Calvo A,et al.Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: A prospective randomized clinical study. Int Orthop. 2012; 36:1877-1883.

[16] Lapner PL, Sabri E, Rakhra K, et al. A multicenter randomized controlled trial comparing single-row with double-row ?xation in arthroscopic rotator cuff repair.J Bone Joint Surg Am. 2012;94:1249-1257.

[17] Aydin N, Kocaoglu B, Guven O. Single-row versus double-row arthroscopic rotator cuff repair in small- to medium-sized tears. J Shoulder Elbow Surg.2010;19:722-5.

[18] Kim DH,Elattrache NS,Tibone JE, et al.Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med. 2006;34: 407-414.

[19] Meier SW, Meier JD. The effect of double-row ?xation on initial repair strength in rotator cuff repair: A biomechanical study. Arthroscopy.2006;22:1168-1173.

[20] Cummins CA, Murrell GA.Mode of failure for rotator cuff repair with suture anchors identi?ed at revision surgery.J Shoulder Elbow Surg.2003;12:128-133.

[21] Wall LB, Keener JD, Brophy RH, et al.Systematic Review Clinical Outcomes of Double-Row Versus Single-Row Rotator Cuff Repairs.Arthroscopy.2009;25(11):1312-1318.

[22] Perser K,Godfrey D,Bisson L.Meta-analysis of Clinical and Radiographic Outcomes After Arthroscopic Single-Row Versus Double-Row Rotator Cuff Repair. Sports Health. 2011; 3(3):268-274

[23] DeHaan AM,Axelrad TW,Kaye E, et al. Does Double-Row Rotator Cuff Repair Improve Functional Outcome of Patients Compared With Single-Row Technique? Am J Sports Med. 2012;40(5):1176-1185.

[24] Bishop J, Klepps S, Lo IK, et al.Cuff integrity after arthroscopic versus open rotator cuff repair: A prospective study.J Shoulder Elbow Surg.2006;15:290-299.

[25] Nho SJ, Brown BS, Lyman S, et al. Prospective analysis of arthroscopic rotatorcuff repair: Prognostic factors affecting clinical and ultrasound outcome. J Shoulder Elbow Surg. 2009;18:13-20.