Delamination of rotator cuff tears impairs healing after repair: a systematic review and meta‐analysis

Abstract

Purpose To compare the clinical outcomes and retear rates after rotator cuf repair (RCR) between delaminated and nondelaminated tears. Methods This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines using the PubMed, Cochrane Library, the Web of Science and Embase databases. Only articles on arthroscopic RCR with clinical outcome scores and data on the number of rotator cuf retears and complete healing were included. This study's relevant data were extracted and statistically analyzed. The methodological index for nonrandomized studies was used to assess the risk of bias in the included studies. After conducting a heterogeneity test and sensitivity analysis to determine whether the samples were heterogeneous, the study also detected publication bias. A sub-group test was used to evaluate the inluences of the imaging follow-up period on retear rates. Results Ten eligible articles were identiied with 2,061 patients (925 in the delaminated group and 1,136 in the nondelaminated group). The meta-analysis demonstrated that delamination was signiicantly associated with higher retear rates (P = 0.026; odds ratio = 1.873, 95% conidence interval 1.079-3.252; I 2 = 51.6%) with an imaging follow-up period of > 1 year and lower rates of complete healing (P = 0.036; odds ratio = 0.659, 95% conidence interval 0.446-0.973; I 2 = 9.0%) in patients after rotator cuf repair. However, no signiicant diferences were observed between the two groups based on American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, external rotation, internal rotation, or forward elevation. Conclusions This meta-analysis found that delamination was signiicantly associated with higher retear rates with imaging follow-up period of > 1 year, and lower rates of complete healing. In addition, the preoperative and postoperative clinical scores and shoulder joint range of motion were similar between patients with delaminated and non-delaminated tears. Level of evidence Level IV.

A Modified Arthroscopic Triple‐row Repair Technique for L‐shaped Delaminated Rotator Cuff Tears

“… 1 , 2 , 3 , 4 , 5 , 6 Delamination is identified as an adverse prognostic element for the healing of rotator cuffs and is correlated with an increased likelihood of retears. 2 , 3 , 7 , 8 Various surgical techniques have been reported for the treatment of delaminated rotator cuff tears, such as double‐row technique (separate double‐row and lamina‐specific double‐row), suture bridge technique (e.g., medially knotted bridge, knotless bridge, layered transosseous‐equivalent, en masse suture bridging, dual‐layer suture bridging, and double‐layer lasso‐loop), bursal layer only repair technique, and arthroscopically assisted mini open technique, and so on. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 These techniques can be divided into en masse repair and separate repair.…”