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The Benefits of Patch Augmentation for Rotator Cuff Repair
Introduction
– The paper is a systematic review and meta-analysis evaluating the clinical outcomes of patch augmentation in rotator cuff repair surgery.
– Patch augmentation aims to mechanically reinforce the repair and improve tendon healing. However, evidence for functional benefits is conflicting.
– Patch augmentation aims to mechanically reinforce the repair and improve tendon healing. However, evidence for functional benefits is conflicting.
Methods
– PRISMA guidelines were followed. 7 interventional studies comparing rotator cuff repair with versus without patch augmentation were included.
– Outcomes analyzed were retear rates, pain, range of motion, strength, and functional scores.
– Meta-analyses were performed to calculate summarized effects. Study quality was assessed using PEDro and GRADE.
– Outcomes analyzed were retear rates, pain, range of motion, strength, and functional scores.
– Meta-analyses were performed to calculate summarized effects. Study quality was assessed using PEDro and GRADE.
Results
– Patch augmentation significantly reduced retear rates (OR 0.32, p<0.001).
– Pain scores were lower with patch augmentation (SMD -0.42, p=0.005).
– UCLA scores improved with patch augmentation (RMD 0.88, p=0.017).
– No difference was seen for Constant, ASES or SST scores.
– A trend toward increased strength (p=0.059) and reduced forward elevation (p=0.066) with patch.
– Methodological quality was low, with high risk of bias in studies.
– Pain scores were lower with patch augmentation (SMD -0.42, p=0.005).
– UCLA scores improved with patch augmentation (RMD 0.88, p=0.017).
– No difference was seen for Constant, ASES or SST scores.
– A trend toward increased strength (p=0.059) and reduced forward elevation (p=0.066) with patch.
– Methodological quality was low, with high risk of bias in studies.
Discussion
– The significant reduction in retear rate supports the mechanical benefit of patch augmentation.
– However, minimal clinically important differences were not reached for pain or UCLA scores.
– No functional improvement was seen on Constant, ASES or SST scores.
– A 2019 RCT found no difference in Constant or SST scores with patch augmentation at 2 years.
– A 2018 meta-analysis also found no clinically significant improvement in functional outcomes with patch.
– Confounding factors like postoperative rehabilitation could contribute to functional outcomes.
– However, minimal clinically important differences were not reached for pain or UCLA scores.
– No functional improvement was seen on Constant, ASES or SST scores.
– A 2019 RCT found no difference in Constant or SST scores with patch augmentation at 2 years.
– A 2018 meta-analysis also found no clinically significant improvement in functional outcomes with patch.
– Confounding factors like postoperative rehabilitation could contribute to functional outcomes.
Conclusion
– Patch augmentation reduces retears but does not translate to clinically meaningful improvement in pain or function compared to repair alone based on current evidence.
– Higher quality randomized trials with standardized rehabilitation protocols are needed to better evaluate functional outcomes with patch augmentation.
– Higher quality randomized trials with standardized rehabilitation protocols are needed to better evaluate functional outcomes with patch augmentation.
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