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Effects of arthroscopic vs. mini-open rotator cuff repair on function, pain & range of motion. A systematic review and meta-analysis.

ABSTRACT: OBJECTIVE:To assess the effectiveness of arthroscopic versus mini-open rotator cuff repair on function, pain and range of motion at 3-, 6- and 12-month follow ups. DESIGN:Systematic review and meta-analysis of randomized controlled trials. SETTING:Clinical setting. PARTICIPANTS:Patients 18 years and older with a rotator cuff tear. INTERVENTION/COMPARISON:Arthroscopic/mini-open rotator cuff repair surgery followed by post operative rehabilitation. MAIN OUTCOME MEASURES:Function and pain. RESULTS:Six RCTs (n = 670) were included. The pooled results, demonstrated no significant difference between arthroscopic and mini open approach to rotator cuff repair on function (very low quality, 4 RCTs, 495 patients, SMD 0.00, 3-month; very low quality, 4 RCTs, 495 patients, SMD -0.01, 6-month; very low quality, 3 RCTs, 462 patients, SMD -0.09, 12-months). For pain, the pooled results, were not statistically different between groups (very low quality, 3 RCTs, 254 patients, MD -0.21, 3-month; very low quality, 3 RCTs, 254 patients, MD -0.03, 6-month; very low quality, 2 RCTs, 194 patients, MD -0.35, 12-months). CONCLUSION:The effects of arthroscopic compared to mini-open rotator cuff repair, on function, pain and range of motion are too small to be clinically important at 3-, 6- and 12-month follow ups.

SUBMITTER: Nazari G

PROVIDER: S-EPMC6822715 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Effects of arthroscopic vs. mini-open rotator cuff repair on function, pain & range of motion. A systematic review and meta-analysis.

Nazari Goris G MacDermid Joy C JC Bryant Dianne D Dewan Neha N Athwal George S GS

PloS one 20191031 10

<h4>Objective</h4>To assess the effectiveness of arthroscopic versus mini-open rotator cuff repair on function, pain and range of motion at 3-, 6- and 12-month follow ups.<h4>Design</h4>Systematic review and meta-analysis of randomized controlled trials.<h4>Setting</h4>Clinical setting.<h4>Participants</h4>Patients 18 years and older with a rotator cuff tear.<h4>Intervention/comparison</h4>Arthroscopic/mini-open rotator cuff repair surgery followed by post operative rehabilitation.<h4>Main outco ...[more]

PMID: 31671101

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Project description:The aim of the study was to compare the clinical outcomes of patients undergoing all-arthroscopic (AA) or mini-open (MO) rotator cuff repair.The present study evaluated 50 patients who had undergone AA repair and 50 patients who had undergone MO repair with a minimum 1-year follow-up. Every patient was asked to complete the Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS) questionnaires. Constant-Murley score (CMS) and active ranges, forward flexion and external rotation, were also evaluated and documented. One year after surgery, ultrasound evaluation was done to determine the integrity of the rotator cuff for each patient.The average age of enrolled patients at the time of surgery was 53.0 years (range, 40-59 years), and average follow-up was 16.6 months (range, 12-24 months). At 2 weeks, the range of forward flexion in the AA group was larger than that in the MO group (136.5?±?10.2 vs 132.5?±?7.7, P?=?0.03). On postoperative day 1, the VAS in the MO group was significantly higher than that in the AA group (6.5?±?0.6 vs 6.1?±?0.6, P?<?0.01). At 1 month, the difference in VAS between both groups reappeared (2.9?±?0.6 vs 2.6?±?0.6, P?=?0.03). At 1 month, the CMS score of patients in the AA group was higher than that in the MO group (52.8?±?3.6 vs 50.9?±?5.0, P?=?0.03). At 3 and 6 months, the DASH score of patients in the AA group was lower than that in the MO group (43.8?±?8.2 vs 47.8?±?4.4, P?<?0.01 and 38.6?±?4.3 vs 42.7?±?9.9, P?<?0.01, respectively). Mean operative time was longer in the AA group compared with that in the MO group (71.9?±?17.6 vs 64.7?±?12.7 minutes, P?<?0.01). Five patients (10.0%) in the AA group and 4 patients (8.2%) in the MO group had rotator cuff retear, and 6 patients (12.0%) in the AA group and 8 patients (16.3%) in the MO group had adhesive capsulitis by the end of follow-up. There is no significant difference between the 2 groups in the incidence of complications. We also found that joint exercising at least 3 times per week was associated with better short- and long-term joint function recovery.The AA approach was associated with less pain and lower DASH score as well as higher CMS score in the early recovery period. No difference was found between the 2 groups in primary and secondary outcomes in the long term, or incidence of complications such as adhesive capsulitis and rotator cuff retear. In conclusion, we consider that the AA procedure has better recovery at short-term follow-ups, while both techniques are equivalent regarding long-term outcomes.

Project description:PurposeTo evaluate patient use of opioids following arthroscopic rotator cuff repair, including the number of days and number of pills when used in combination with non-opioid medications and to determine whether patients were satisfied with their pain management and if variables such as age, sex, body mass index, duration of symptoms, anticipation of postoperative pain, preoperative opioid consumption, size of the rotator cuff tear, or anxiety/depression affected pain management.MethodsThis was a prospective cohort study of 117 prospectively enrolled patients older than the age of 18 years undergoing primary arthroscopic rotator cuff repair. All patients completed preoperative and 2-week postoperative questionnaires to assess their pain and satisfaction with pain management. Univariate and multivariate analyses were performed to evaluate the association of patient characteristics with satisfaction of pain control and amount/duration of opioids postoperatively.ResultsPatients required a median of 18 opioid pain pills or 135 morphine milligram equivalents (interquartiles, 6-35 pills) postoperatively over 6.9 ± 5.1 days. In total, 65% of patients took opioid pain medications for 7 days or fewer. On postoperative day 2, patients reported a VAS pain score of 6.6 ± 2.8 and at the 2-week postoperative visit, mean visual analog scale pain score was 3.5 ± 2.5. Differences in age, sex, body mass index, duration of symptoms, anticipation of postoperative pain, preoperative 2-item Patient Health Questionnaire, 2-item Pain Self-Efficacy Questionnaire, current opioid use, and surgical characteristics had no effect on, or association with, satisfaction with pain management postoperatively.ConclusionsFollowing arthroscopic rotator cuff repair, patients can achieve satisfactory pain control using a multimodal approach with a median of 18 opioid pills (range 6-35 pills) over 6.9 ± 5.1 days when used in combination with non-opioid pain medications. Overall, 74.4% of patients were satisfied with their postoperative pain management.Level of evidenceLevel II; Prospective cohort study.

Dataset Information

Effects of arthroscopic vs. mini-open rotator cuff repair on function, pain & range of motion. A systematic review and meta-analysis.

Publications

Effects of arthroscopic vs. mini-open rotator cuff repair on function, pain & range of motion. A systematic review and meta-analysis.

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