Key result
Graft bridging resulted in significantly greater improvements in the Constant-Murley score compared to superior capsule reconstruction (41.9 vs 19.8) for large to massive rotator cuff tears.
Why the study?
Outcome differences between graft bridging and superior capsule reconstruction for large to massive rotator cuff tears remain unclear.
Does graft bridging improve clinical outcomes compared to superior capsule reconstruction in patients with large to massive rotator cuff tears?
Systematic Review (n=831)
Does graft bridging improve clinical outcomes compared to superior capsule reconstruction in patients with large to massive rotator cuff tears?
Graft bridging showed significantly better clinical and functional outcomes postoperatively than superior capsule reconstruction for large to massive rotator cuff tears.
GB may yield superior outcomes versus SCR for massive RCTs; hypothesis-generating pending direct RCTs.
Background: Graft bridging (GB) and superior capsule reconstruction (SCR) were developed to treat large to massive rotator cuff tears (RCTs); however, the outcome differences between GB and SCR remain unclear. Purpose: To systematically review and compare the outcomes of GB and SCR for large to massive RCT. Study Design: Systematic review. Methods: A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of GB or SCR were included according to the inclusion and exclusion criteria. The primary outcome was Constant-Murley score at the final follow-up. Secondary outcomes included the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, active shoulder range of motion, and graft healing rate. Complication rate was the safety outcome measure. Outcomes were summarized into group SCR and group GB, and the results were compared statistically ( P < .05). Results: A total of 23 studies were included in this review: 238 repairs from the 5 studies in group SCR and 593 repairs from the 18 studies in group GB. For group SCR and group GB, the mean age was 61.6 and 63.3 years, and the mean follow-up was 18.0 and 40.1 months, respectively. Overall, both procedures demonstrated improvement of clinical outcomes. When compared with group SCR, group GB had significantly higher mean differences of the Constant-Murley score (41.9 vs 19.8), American Shoulder and Elbow Surgeons score (39.3 vs 33.8), visual analog scale score for pain (4.4 vs 3.4), and active external rotation at side (15.3 vs 9.3). No statistically significant difference was detected in the mean difference of active forward flexion, internal rotation, abduction, and graft healing rate between the groups. The complication rates were 0.84% (2 of 238) in group SCR and 0.67% (4 of 593) in group GB. Conclusion: In general, GB showed significantly better clinical and functional outcomes postoperatively than SCR, with a similar complication rate. The available fair-quality evidence suggested that GB might be a better choice for large to massive RCT. More high-quality randomized controlled studies are required to further evaluate the relative benefits of the 2 procedures.
No takes yet. Share an insight, caveat, or question.
Lin et al. (2019) conducted a systematic review in Large to massive rotator cuff tears (n=831). Graft bridging vs. Superior capsule reconstruction was evaluated on Constant-Murley score at the final follow-up (p=<.05). Graft bridging resulted in significantly greater improvements in the Constant-Murley score compared to superior capsule reconstruction (41.9 vs 19.8) for large to massive rotator cuff tears.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: